Impact of academic detailing on primary care physicians
- Supplement
KCE reports 125S
Federaal Kenniscentrum voor de Gezondheidszorg Centre fédéral d’expertise des soins de santé
Belgian Health Care Knowledge Centre 2010
The Belgian Health Care Knowledge Centre
Introduction: The Belgian Health Care Knowledge Centre (KCE) is an organization of public interest, created on the 24th of December 2002 under the supervision of the Minister of Public Health and Social Affairs. KCE is in charge of conducting studies that support the political decision making on health care and health insurance.
Administrative Council
Actual Members: Pierre Gillet (President), Dirk Cuypers (Vice-president), Jo De Cock (Vice-president), Frank Van Massenhove (Vice-president), Yolande Avondtroodt, Jean-Pierre Baeyens, Ri de Ridder, Olivier De Stexhe, Johan Pauwels, Daniel Devos, Jean-Noël Godin, Floris Goyens, Jef Maes, Pascal Mertens, Marc Moens, Marco Schetgen, Patrick Verertbruggen, Michel Foulon, Myriam Hubinon, Michael Callens, Bernard Lange, Jean-Claude Praet.
Substitute Members: Rita Cuypers, Christiaan De Coster, Benoît Collin, Lambert Stamatakis, Karel Vermeyen, Katrien Kesteloot, Bart Ooghe, Frederic Lernoux, Anne Vanderstappen, Paul Palsterman, Geert Messiaen, Anne Remacle, Roland Lemeye, Annick Poncé, Pierre Smiets, Jan Bertels, Catherine Lucet, Ludo Meyers, Olivier Thonon, François Perl.
Government commissioner: Yves Roger
Management
Chief Executive Officer: Raf Mertens
Assistant Chief Executive Officer: Jean-Pierre Closon
Information
Federaal Kenniscentrum voor de gezondheidszorg - Centre fédéral d’expertise des soins de santé – Belgian Health Care Knowlegde Centre. Centre Administratif Botanique, Doorbuilding (10th floor) Boulevard du Jardin Botanique 55 B-1000 Brussels Belgium Tel: +32 [0]2 287 33 88 Fax: +32 [0]2 287 33 85 Email : [email protected] Web : http://www.kce.fgov.be
Impact of academic detailing on primary care physicians -
Supplement
KCE reports 125S
LIESBETH BORGERMANS, CÉCILE DUBOIS, STÉPHANE RIEPPI, STÉPHANIE VANHAEREN, NICK GEUKENS, CATHÉRINE FALLON, FRÉDÉRIC CLAISSE,
CLÉMENCE MASSART, SÉBASTIEN BRUNET, LAURENCE KOHN, JULIEN PIÉRART, DOMINIQUE PAULUS
Federaal Kenniscentrum voor de Gezondheidszorg Centre fédéral d’expertise des soins de santé
Belgian Health Care Knowledge Centre 2010
KCE reports 125S
Title : Impact of academic detailing on primary care physicians - Supplement
Authors: Liesbeth Borgermans (Medsat, Tremelo), Cécile Dubois (KCE), Stéphane Rieppi (SPIRAL, ULg), Stéphanie Vanhaeren (SPIRAL, ULg), Nick Geukens (SPIRAL, ULg), Catherine Fallon (SPIRAL, ULg), Frédéric Claisse (SPIRAL, ULg), Clémence Massart (SPIRAL, ULg), Sébastien Brunet (SPIRAL, ULg), Laurence Kohn (KCE), Julien Piérart (KCE), Dominique Paulus (KCE)
External experts: Marie-Louise Bouffioux (Agence Fédérale des Médicaments et Produits de Santé – Federaal Agentschap voor geneesmiddelen en Gezondheidsproducten, Brussels), Carl Cauwenbergh (Institut national d’assurance maladie-invalidité – Rijksinstituut voor ziekte- en invaliditeitsverzekering, Brussels), Patricia Eeckeleers (general Practitioner (Leignon), Scientific Society of General Practice, Brussels), Xavier de Bethune (Alliance Nationale des Mutualités Chrétiennes - Christelijke Mutualiteiten, Brussels), Marc Vanmeerbeeck (Department of General Practice, ULg)
Acknowledgements: all GPs who participated to the qualitative study, Géraldine André (ULg), Nancy Thiry (KCE), Stephan Devriese (KCE), Stefaan Van De Sande (KCE)
External validators: Benoît Boland (UCL academic hospital, Brussels), Paul De Cort (University Centre for General Practice, KULeuven), Malcolm Maclure (School of Health Information Science, University of Victoria, BC, Canada and Harvard School of Public Health, Boston, MA, US)
Conflict of interest: No conflict declared in relation with the topic of the report
Disclaimer: The external experts were consulted about a (preliminary) version of the scientific report. Subsequently, a (final) version was submitted to the validators.. The validation of the report results from a consensus or a voting process between the validators. Only the KCE is responsible for errors or omissions that could persist. The policy recommendations are also under the full responsibility of the KCE.
Layout: Ine Verhulst
Brussels, 29th March 2010
Study nr 2009-21
Domain: Health Services Research (HSR)
MeSH: Academic Detailing ; Physicians, Family ; Physicians
Classification: W20
Language: English
Format: Adobe® PDF™ (A4)
Legal depot: D/2010/10.273/17
Any partial reproduction of this document is allowed if the source is indicated. This document is available on the website of the Belgian Health Care Knowledge Centre.
How to refer to this document?
Borgermans L, Dubois C, Rieppi S, Vanhaeren S, Geukens N, Fallon C, Claisse F, Massart C, Brunet S, Kohn L, Piérart J, Paulus D. Impact of academic detailing on primary care physicians - Supplement. Health Services Research (HSR). Brussels: Belgian Health Care Knowledge Centre (KCE). 2010. KCE Reports 125S. D/2010/10.273/17
KCE Reports 125 Academic Detailing – Supplement 1
Appendices academic detailing Table of contents
1! APPENDICES LITERATURE REVIEW ......................................................................... 3!
1.1! DEFINITION OF TERMS ............................................................................................................................ 3!
1.2! QUALITY APPRAISAL OF THE REVIEWS OF REVIEWS AND SYSTEMATIC REVIEWS .......... 4!1.2.1! REVIEWS OF SYSTEMATIC REVIEWS ....................................................................................... 4!1.2.2! SYSTEMATIC REVIEWS ............................................................................................................... 11!
1.3! PRIMARY STUDIES: EXCLUSION -QUALITY APPRAISAL ............................................................. 35!1.3.1! Studies excluded on the basis of full text: reason for exclusion .......................................... 35!1.3.2! Quality appraisal of the 87 studies included ............................................................................. 36!1.3.3! Elements used to describe the studies on academic detailing .............................................. 39!
1.4! OVERVIEW OF THE SELECTED PAPERS ............................................................................................ 40!1.4.1! Description of the reviews of reviews ....................................................................................... 40!1.4.2! Selected systematic reviews and source articles in these reviews ...................................... 41!1.4.3! Overview of the 87 studies on academic detailing. ................................................................. 46!
1.5! DESCRIPTION OF THE 87 STUDIES SELECTED .............................................................................. 66!
2! APPENDICES QUALITATIVE PART ....................................................................... 240!
2.1! APPENDIX A: PHONE SCRIPT (FRENCH) ....................................................................................... 240!
2.2! APPENDIX B: MAIN FIVE QUESTIONS, USED AS A GUIDE FOR THE FIRST INTERVIEWS (FRENCH) .................................................................................................................................................. 240!
2.3! APPENDIX C: CHARACTERISTICS OF FACE-TO-FACE INTERVIEWEES .............................. 241!
2.4! APPENDIX D. MAIN TOPICS TO BE INVESTIGATED, IN A GRID (FRENCH) ..................... 243!
2.5! APPENDIX E: INVITATION MAIL TEXTS ......................................................................................... 244!2.5.1! Version in French ......................................................................................................................... 244!2.5.2! Version in Dutch .......................................................................................................................... 245!
2.6! APPENDIX F: WEB WELCOME (LOGGED-IN) TEXT .................................................................. 246!2.6.1! Version in French ......................................................................................................................... 246!2.6.2! Version in Dutch .......................................................................................................................... 247!
2.7! APPENDIX G: MESYDEL PARTICIPANTS ......................................................................................... 248!2.7.1! Contacted GPs for the Mesydel session: response rates .................................................... 248!2.7.2! Characteristics of the Mesydel participants ............................................................................ 249!
2.8! APPENDIX H: QUESTIONS FOR THE FIRST MESYDEL ROUND ............................................. 252!2.8.1! Version in French ......................................................................................................................... 252!2.8.2! Version in Dutch .......................................................................................................................... 252!
2.9! APPENDIX I. QUESTIONS FOR THE SECOND MESYDEL ROUND ........................................ 253!2.9.1! Version in French ......................................................................................................................... 253!2.9.2! Version in Dutch .......................................................................................................................... 254!
2.10! APPENDIX J: DISCUSSION OF THE MESYDEL QUESTIONS ..................................................... 256!2.10.1!Round 1 .......................................................................................................................................... 256!2.10.2!Round 2 .......................................................................................................................................... 256!
3! APPENDICES - ANALYSIS OF IMA DATABASE ................................................... 260!
3.1! DIABETES TOPIC ............................................................................................................................... ...... 260!3.1.1! Descriptive statistics: number of patients by GP – Overall Population ............................ 260!3.1.2! Age distribution of the patients analyzed for Diabetes – Overall Population ................. 260!3.1.3! Number (%) of patients by type of therapy given before and after the AD visit for the diabetes topic – Overall Population ...................................................................................................... 260!
2 Academic Detailing – Supplement KCE Reports 125
3.1.4! Number (%) of Patients by type of therapy given before and after the AD visit for diabetes topic – “Complete” Cases Subgroup ................................................................................... 261!3.1.5! Volume (in number of Defined Daily Doses) by Group of Medications, Population and Semesters – Diabetes ............................................................................................................................... 262!3.1.6! Proportion (in %) of the Medications prescriptions by Group of Medications, Population and Semesters – Diabetes ....................................................................................................................... 267!
3.2! DEMENTIA TOPIC .................................................................................................................................. 272!3.2.1! Descriptive statistics of the number of patients by GP – Overall Population ................. 272!3.2.2! Age distribution of the Patients analyzed for Dementia – Overall Population ............... 272!3.2.3! Number (%) of Patients by type of therapy given before and after the AD Visit for dementia topic – Overall Population .................................................................................................... 273!3.2.4! Volume (in number of Defined Daily Doses) by Group of Medications, Population and Semesters – Dementia ............................................................................................................................. 275!
KCE Reports 125 Academic Detailing – Supplement 3
1 APPENDICES LITERATURE REVIEW 1.1 DEFINITION OF TERMS
PICO Search terms
POPULATION:
PHYSICIANS
Mesh Physicians; Physicians, Family; Specialism
Emtree Physician; Medical specialist; Thesaurus psychinfo; Physicians (to explode)
Thesaurus Eric Physicians; Medicine
Key words Physicians; General practitioner; Specialist
Intervention: oral individual academic detailing Mesh
Education, Medical, Continuing Emtree
Medical education; Academic advisement; Continuing education; Lifelong learning; In service training; Learning environment
Thesaurus psychinfo Medical education; professional development; continuing education
Thesaurus Eric Academic advising; Allied health occupations education; Medical education; Professional continuing education; Outreach programmes; Intervention
Key words Academic detail*; Educational outreach visit; Face-to-face visit; Educational visit*; Education method; Educational intervention; Information method; Oral; Individual; Face-to-face
INTERVENTION: ORAL
INDIVIDUAL ACADEMIC DETAILING
Mesh Education, Medical, Continuing
Emtree Medical education; Academic advisement; Continuing education; Lifelong learning; In service training; Learning environment
Thesaurus psychinfo Medical education; professional development; continuing education
Thesaurus Eric Academic advising; Allied health occupations education; Medical education; Professional continuing education; Outreach programmes; Intervention
Key words Academic detail*; Educational outreach visit; Face-to-face visit; Educational visit*; Education method; Educational intervention; Information method; Oral; Individual; Face-to-face
COMPARISON: OTHER INDEPENDENT EDUCATIONAL TECHNIQUES
Mesh Education, Medical, Continuing
Emtree Educational model; Continuing education provider
Thesaurus psychinfo Medical education; professional development; continuing education
Thesaurus Eric Teaching methods; Educational strategies
Key words Audit; Feedback; Written information; Social marketing; Collective/group outreach visit; Education method; Educational intervention; Information method
OUTCOME: PHYSICIAN’S MEDICAL PRACTICE
Mesh
Drug prescription; Drug utilisation; Decision making; Outcome assessment (healthcare); Physicians practice patterns; Professional practice; Treatment outcome
Emtree General practice; Family practice; Medical practice; Medical decision making; Clinical practice; Clinical decision making; Social marketing; Prescription
Thesaurus psychinfo Prescribing (drugs); Prescription drugs; Clinical Practice; Evidence Based Practice; Therapeutic Processes/
Thesaurus Eric Drug therapy; Medical services; Medical care evaluation
Key words Prevention; Prescrib* practice; Prescrib* behavio(u)r; Physician’s level of knowledge; Clinical practice
The search strategies are available upon request
4 Academic Detailing – Supplement KCE Reports 125
1.2 QUALITY APPRAISAL OF THE REVIEWS OF REVIEWS AND SYSTEMATIC REVIEWS
1.2.1 REVIEWS OF SYSTEMATIC REVIEWS
1. BLOOM, 2005 Bloom BS. Effects of continuing medical education on improving physician clinical care and patient health: a review of systematic reviews. International Journal of Technology Assessment in Health Care. 2005;21(3):380-5. TITLE:
Mentions review of systematic reviews
ABSTRACT (structured summary) Background YES Objectives YES Data sources YES Study elegibility criteria YES Participants YES Interventions YES Study appraisal and synthesis methods NO Review methods NO Limitations NO Results YES Conclusion YES Implications of key findings YES Systematic review registration number NO INTRODUCTION
The explicit rationale for the interventions and rationale for the review is provided: YES
Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS): YES METHODS
Protocol and registration
Indicates if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provides a registration information including registration number: NO
Eligibility criteria Specifies study characteristics (e.g., PICOS, length of follow"up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale: YES
Information sources Describes all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched: YES
Search Presents full electronic search strategy for at least one database, including any limits used, such that it could be repeated: NO
Study selection State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta"analysis): YES
Data collection process
Describes method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators: YES
Data items Lists and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made: NO
Risk of bias in individual
studies
Describes methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis: NO
Summary measures States the principal summary measures (e.g., risk ratio, difference in means): YES Synthesis of results Describes the methods of handling data and combining results of studies, if done, including
measures of consistency (e.g., I2 ) for each meta"analysis: NO Risk of bias across studies
Specifies any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies): NO
Additional analyses Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre"specified: NO
RESULTS
KCE Reports 125 Academic Detailing – Supplement 5
Study selection Gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram: YES (but no flow diagram)
Study characteristics For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations: NO
Risk of bias within studies Present data on risk of bias of each study and, if available, any outcome level assessment: NO Results of individual studies
For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot: NO
Synthesis of results Presents results of each meta-analysis done, including confidence intervals and measures of consistency: YES
Risk of bias across studies
Presents results of any assessment of risk of bias across studies: NO
Additional analysis Gives results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression: NO
DISCUSSION
Summary of evidence Summarizes the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers): YES
Limitations Discusses limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias): NO
Conclusions Provides a general interpretation of the results in the context of other evidence, and implications for future research: YES
Funding Describes sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review: NO
APPRAISAL
- The SR presents a substantial number of limitations when assessing the items of the PRISMA statement checklist.
2. GRINDROD, 2006 Grindrod KA, Patel P, Martin JE. What interventions should pharmacists employ to impact health practitioners' prescribing practices? Ann Pharmacother. 2006;40(9):1546-57. TITLE:
Does not mention a review of systematic reviews ABSTRACT: YES
Background YES Objectives YES Data sources YES Study elegibility criteria YES Participants YES Interventions YES Study appraisal and synthesis methods NO Review methods NO Limitations NO Results YES Conclusion YES Implications of key findings YES Systematic review registration number NO INTRODUCTION
The explicit rationale for the interventions and rationale for the review is provided: YES
Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS): YES, but not presented as PICO METHODS
Protocol and registration
Indicates if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provides a registration information including registration number: NO
Eligibility criteria Specifies study characteristics (e.g., PICOS, length of follow"up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale:
6 Academic Detailing – Supplement KCE Reports 125
YES
Information sources Describes all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched: YES
Search Presents full electronic search strategy for at least one database, including any limits used, such that it could be repeated: NO
Study selection State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta"analysis): YES
Data collection process
Describes method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators: YES
Data items Lists and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made: YES
Risk of bias in individual
studies
Describes methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis: NO
Summary measures States the principal summary measures (e.g., risk ratio, difference in means): YES Synthesis of results Describes the methods of handling data and combining results of studies, if done, including
measures of consistency (e.g., I2 ) for each meta"analysis: NO META-ANALYSIS Risk of bias across studies
Specifies any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies): NO
Additional analyses Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre"specified: NO
RESULTS
Study selection Gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram: YES, with flow diagram
Study characteristics For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations: YES
Risk of bias within studies Present data on risk of bias of each study and, if available, any outcome level assessment: NO Results of individual studies
For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot: NO
Synthesis of results Presents results of each meta-analysis done, including confidence intervals and measures of consistency: NO
Risk of bias across studies
Presents results of any assessment of risk of bias across studies: NO
Additional analysis Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression: NO
DISCUSSION
Summary of evidence Summarizes the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers): YES
Limitations Discusses limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias): YES
Conclusions Provides a general interpretation of the results in the context of other evidence, and implications for future research: YES
Funding Describes sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review: NO
APPRAISAL
- The SR presents a substantial number of limitations when assessing the items of the PRISMA statement checklist.
- A non quantitative summary of the reported results was performed using a vote-counting method
KCE Reports 125 Academic Detailing – Supplement 7
3. LANDRY, 2002 Landry MD, Sibbald WJ. Changing physician behavior: a review of patient safety in critical care medicine. J Crit Care. 2002;17(2):138-45. TITEL:
Does not mention review of systematic reviews
ABSTRACT: YES
Background YES Objectives YES Data sources NO Study elegibility criteria NO Participants NO Interventions YES Study appraisal and synthesis methods NO Review methods NO Limitations NO Results NO Conclusion NO Implications of key findings NO Systematic review registration number NO INTRODUCTION
The explicit rationale for the interventions and rationale for the review is provided: YES
Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS): NO METHODS
Protocol and registration
Indicates if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provides aregistration information including registration number: NO
Eligibility criteria Specifies study characteristics (e.g., PICOS, length of follow"up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale: NO
Information sources Describes all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched: NO
Search Presents full electronic search strategy for at least one database, including any limits used, such that it could be repeated: NO
Study selection State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta"analysis): NO
Data collection process
Describes method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators: NO
Data items Lists and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made: NO
Risk of bias in individual
studies
Describes methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis: NO
Summary measures States the principal summary measures (e.g., risk ratio, difference in means): NO Synthesis of results Describes the methods of handling data and combining results of studies, if done, including
measures of consistency (e.g., I2 ) for each meta"analysis: NO Risk of bias across studies
Specifies any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies): NO
Additional analyses Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre"specified: NO
RESULTS
Study selection Gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram: NO
Study characteristics For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations: YES
Risk of bias within studies Present data on risk of bias of each study and, if available, any outcome level assessment: NO
8 Academic Detailing – Supplement KCE Reports 125
Results of individual studies
For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot: NO
Synthesis of results Presents results of each meta-analysis done, including confidence intervals and measures of consistency: NO
Risk of bias across studies
Presents results of any assessment of risk of bias across studies: NO
Additional analysis Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression: NO
DISCUSSION
Summary of evidence Summarizes the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers): YES
Limitations Discusses limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias): NO
Conclusions Provides a general interpretation of the results in the context of other evidence, and implications for future research: YES
Funding Describes sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review: NO
APPRAISAL
- The SR presents a substantial number of limitations when assessing the items of the PRISMA statement checklist.
4. SATTERLEE, 2008 Satterlee WG, Eggers RG, Grimes DA. Effective medical education: Insights from the cochrane library. Obstetrical and Gynecological Survey. 2008;63(5):329-33. TITEL:
Mentions a systematic review
ABSTRACT: YES
Background YES Objectives YES Data sources YES Study elegibility criteria YES Participants YES Interventions YES Study appraisal and synthesis methods YES Review methods YES Limitations YES Results YES Conclusion YES Implications of key findings YES Systematic review registration number YES INTRODUCTION
The explicit rationale for the interventions and rationale for the review is provided: YES
Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS): METHODS
Protocol and registration
Indicates if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provides aregistration information including registration number: NO
Eligibility criteria Specifies study characteristics (e.g., PICOS, length of follow"up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale: YES
Information sources Describes all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched: YES
Search Presents full electronic search strategy for at least one database, including any limits used, such that it could be repeated: YES
Study selection State the process for selecting studies (i.e., screening, eligibility, included in systematic review,
KCE Reports 125 Academic Detailing – Supplement 9
and, if applicable, included in the meta"analysis): YES Data collection process
Describes method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators: YES
Data items Lists and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made: YES
Risk of bias in individual
studies
Describes methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis: NO
Summary measures States the principal summary measures (e.g., risk ratio, difference in means): YES Synthesis of results Describes the methods of handling data and combining results of studies, if done, including
measures of consistency (e.g., I2 ) for each meta"analysis: NO Risk of bias across studies
Specifies any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies): NO
Additional analyses Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre"specified: NO
RESULTS
Study selection Gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram: YES, no flow diagram
Study characteristics For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations: NO
Risk of bias within studies Present data on risk of bias of each study and, if available, any outcome level assessment: NO Results of individual studies
For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot: NO
Synthesis of results Presents results of each meta-analysis done, including confidence intervals and measures of consistency: NO
Risk of bias across studies
Presents results of any assessment of risk of bias across studies: NO
Additional analysis Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression: NO
DISCUSSION
Summary of evidence Summarizes the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers): YES
Limitations Discusses limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias): NO
Conclusions Provides a general interpretation of the results in the context of other evidence, and implications for future research: NO
Funding Describes sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review: NO
APPRAISAL
- The SR presents a limited limitations when assessing the items of the PRISMA statement checklist.
- Only Cochrane database consulted
10 Academic Detailing – Supplement KCE Reports 125
5. SOHN, 2004 Sohn W, Ismail AI, Tellez M. Efficacy of educational interventions targeting primary care providers' practice behaviors: an overview of published systematic reviews. Journal of Public Health Dentistry. 2004;64(3):164-72. TITEL:
Title mentions a review of systematic review
ABSTRACT: YES
Background YES Objectives YES Data sources YES Study elegibility criteria YES Participants YES Interventions YES Study appraisal and synthesis methods YES Review methods YES Limitations NO Results YES Conclusion YES Implications of key findings YES Systematic review registration number NO INTRODUCTION
The explicit rationale for the interventions and rationale for the review is provided: YES
Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS): YES METHODS
Protocol and registration
Indicates if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provides a registration information including registration number: NO
Eligibility criteria Specifies study characteristics (e.g., PICOS, length of follow"up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale: YES
Information sources Describes all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched: YES
Search Presents full electronic search strategy for at least one database, including any limits used, such that it could be repeated: YES
Study selection State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta"analysis): YES
Data collection process
Describes method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators: YES
Data items Lists and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made: YES
Risk of bias in individual
studies
Describes methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis: NO
Summary measures States the principal summary measures (e.g., risk ratio, difference in means): NO Synthesis of results Describes the methods of handling data and combining results of studies, if done, including
measures of consistency (e.g., I2 ) for each meta"analysis: YES Risk of bias across studies
Specifies any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies): NO
Additional analyses Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre"specified: NO
RESULTS
Study selection Gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram: YES, but no flow diagram
Study characteristics For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations: YES
Risk of bias within studies Present data on risk of bias of each study and, if available, any outcome level assessment: NO
KCE Reports 125 Academic Detailing – Supplement 11
Results of individual studies
For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot: NO
Synthesis of results Presents results of each meta-analysis done, including confidence intervals and measures of consistency: NO
Risk of bias across studies
Presents results of any assessment of risk of bias across studies: NO
Additional analysis Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression: NO
DISCUSSION
Summary of evidence Summarizes the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers): YES
Limitations Discusses limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias): YES
Conclusions Provides a general interpretation of the results in the context of other evidence, and implications for future research: YES
Funding Describes sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review: NO
APPRAISAL
- The SR presents a moderate number of limitations when assessing the items of the PRISMA statement checklist
1.2.2 SYSTEMATIC REVIEWS
1. Arnold, 2005 Arnold SR, Straus SE. Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database of Systematic Reviews. 2005;4(4):CD003539. TITEL:
Does mention a systematic review
ABSTRACT: YES
Background YES Objectives YES Data sources YES Study elegibility criteria YES Participants YES Interventions YES Study appraisal and synthesis methods YES Review methods YES Limitations YES Results YES Conclusion YES Implications of key findings YES Systematic review registration number YES INTRODUCTION
The explicit rationale for the interventions and rationale for the review is provided: YES
Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS): YES METHODS
Protocol and registration
Indicates if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provides aregistration information including registration number: YES
Eligibility criteria Specifies study characteristics (e.g., PICOS, length of follow"up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale: YES
Information sources Describes all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched: YES
Search Presents full electronic search strategy for at least one database, including any limits used, such that it could be repeated: YES
12 Academic Detailing – Supplement KCE Reports 125
Study selection State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta"analysis): YES
Data collection process
Describes method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators: YES
Data items Lists and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made: YES
Risk of bias in individual
studies
Describes methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis: YES
Summary measures States the principal summary measures (e.g., risk ratio, difference in means): YES Synthesis of results Describes the methods of handling data and combining results of studies, if done, including
measures of consistency (e.g., I2 ) for each meta"analysis: NO Risk of bias across studies
Specifies any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies): YES
Additional analyses Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre"specified: NO
RESULTS
Study selection Gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram: YES
Study characteristics For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations: YES
Risk of bias within studies Present data on risk of bias of each study and, if available, any outcome level assessment: YES Results of individual studies
For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot: YES
Synthesis of results Presents results of each meta-analysis done, including confidence intervals and measures of consistency: NA
Risk of bias across studies
Presents results of any assessment of risk of bias across studies: YES
Additional analysis Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression: NO
DISCUSSION
Summary of evidence Summarizes the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers): YES
Limitations Discusses limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias): YES
Conclusions Provides a general interpretation of the results in the context of other evidence, and implications for future research: YES
Funding Describes sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review: YES
APPRAISAL
- With the exception of a limited number of items, all items are represented as required by the PRISMA statement checklist.
KCE Reports 125 Academic Detailing – Supplement 13
2. CHAILLET, 2006 Chaillet N, Dube E, Dugas M, Audibert F, Tourigny C, Fraser WD, et al. Evidence-based strategies for implementing guidelines in obstetrics: a systematic review. Obstet Gynecol. 2006;108(5):1234-45. TITEL:
Does mention a systematic review
ABSTRACT: YES
Background YES Objectives YES Data sources YES Study elegibility criteria YES Participants YES Interventions YES Study appraisal and synthesis methods YES Review methods YES Limitations NO Results YES Conclusion YES Implications of key findings YES Systematic review registration number NO INTRODUCTION
The explicit rationale for the interventions and rationale for the review is provided: YES
Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS): YES METHODS
Protocol and registration
Indicates if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provides a registration information including registration number: NO
Eligibility criteria Specifies study characteristics (e.g., PICOS, length of follow"up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale: YES
Information sources Describes all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched: YES
Search Presents full electronic search strategy for at least one database, including any limits used, such that it could be repeated: NO
Study selection State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta"analysis): YES
Data collection process
Describes method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators: YES
Data items Lists and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made: YES
Risk of bias in individual
studies
Describes methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis: YES
Summary measures States the principal summary measures (e.g., risk ratio, difference in means): NO Synthesis of results Describes the methods of handling data and combining results of studies, if done, including
measures of consistency (e.g., I2 ) for each meta"analysis: NO Risk of bias across studies
Specifies any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies): NO
Additional analyses Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre"specified: NO
RESULTS
Study selection Gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram: YES, but no flow diagram
Study characteristics For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations: YES
Risk of bias within Present data on risk of bias of each study and, if available, any outcome level assessment: YES
14 Academic Detailing – Supplement KCE Reports 125
studies
Results of individual studies
For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot: YES
Synthesis of results Presents results of each meta-analysis done, including confidence intervals and measures of consistency: NA
Risk of bias across studies
Presents results of any assessment of risk of bias across studies: NA
Additional analysis Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression: NA
DISCUSSION
Summary of evidence Summarizes the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers): YES
Limitations Discusses limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias): YES
Conclusions Provides a general interpretation of the results in the context of other evidence, and implications for future research: YES
Funding Describes sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review: NO
APPRAISAL
- The SR presents some limitations when assessing the items of the PRISMA statement checklist since e.g. a profile summarising trail flow is not presented.
3. FISH, 2002 Fish A, Watson MC, Bond CM. Practice-based pharmaceutical services: A systematic review. Int. J. Pharm. Pract. 2002;10(4):225-33. TITEL:
Does mention a systematic review
ABSTRACT: YES
Background Objectives Data sources Study elegibility criteria Participants Interventions Study appraisal and synthesis methods Review methods Limitations Results Conclusion Implications of key findings Systematic review registration number INTRODUCTION
The explicit rationale for the interventions and rationale for the review is provided: YES
Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS): METHODS
Protocol and registration
Indicates if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provides aregistration information including registration number:
Eligibility criteria Specifies study characteristics (e.g., PICOS, length of follow"up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale:
Information sources Describes all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched:
Search Presents full electronic search strategy for at least one database, including any limits used, such that it could be repeated:
KCE Reports 125 Academic Detailing – Supplement 15
Study selection State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta"analysis):
Data collection process
Describes method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators:
Data items Lists and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made:
Risk of bias in individual
studies
Describes methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis:
Summary measures States the principal summary measures (e.g., risk ratio, difference in means): Synthesis of results Describes the methods of handling data and combining results of studies, if done, including
measures of consistency (e.g., I2 ) for each meta"analysis: Risk of bias across studies
Specifies any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies):
Additional analyses Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre"specified:
RESULTS
Study selection Gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram:
Study characteristics For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations:
Risk of bias within studies Present data on risk of bias of each study and, if available, any outcome level assessment: Results of individual studies
For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot:
Synthesis of results Presents results of each meta-analysis done, including confidence intervals and measures of consistency:
Risk of bias across studies
Presents results of any assessment of risk of bias across studies:
Additional analysis Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression:
DISCUSSION
Summary of evidence Summarizes the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers):
Limitations Discusses limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias):
Conclusions Provides a general interpretation of the results in the context of other evidence, and implications for future research:
Funding Describes sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review:
APPRAISAL
- The SR presents some limitations when assessing the items of the PRISMA statement checklist
16 Academic Detailing – Supplement KCE Reports 125
4. GRIMSHAW, 2001 Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, et al. Changing provider behavior: an overview of systematic reviews of interventions. Med Care. 2001;39(8 Suppl 2):II2-45. TITEL:
Does mention systematic review
ABSTRACT: YES
Background YES Objectives YES
Data sources YES
Study elegibility criteria
YES
Participants YES
Interventions YES
Study appraisal and synthesis methods
YES
Review methods YES
Limitations YES
Results YES
Conclusion YES
Implications of key findings
YES
Systematic review registration number NO INTRODUCTION
The explicit rationale for the interventions and rationale for the review is provided: YES
Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS): YES METHODS
Protocol and registration
Indicates if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provides a registration information including registration number: NO
Eligibility criteria Specifies study characteristics (e.g., PICOS, length of follow"up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale: YES
Information sources Describes all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched: YES
Search Presents full electronic search strategy for at least one database, including any limits used, such that it could be repeated: NO
Study selection State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta"analysis): YES
Data collection process
Describes method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators: NO
Data items Lists and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made: NO
Risk of bias in individual
studies
Describes methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis: NO
Summary measures States the principal summary measures (e.g., risk ratio, difference in means): NO Synthesis of results Describes the methods of handling data and combining results of studies, if done, including
measures of consistency (e.g., I2 ) for each meta"analysis: NO Risk of bias across studies
Specifies any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies): NO
Additional analyses Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre"specified: NO
RESULTS
Study selection Gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram: YES
Study characteristics For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations: YES
Risk of bias within studies Present data on risk of bias of each study and, if available, any outcome level assessment: YES
KCE Reports 125 Academic Detailing – Supplement 17
Results of individual studies
For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot: YES
Synthesis of results Presents results of each meta-analysis done, including confidence intervals and measures of consistency: NA
Risk of bias across studies
Presents results of any assessment of risk of bias across studies: NO
Additional analysis Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression: NO
DISCUSSION
Summary of evidence Summarizes the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers): YES
Limitations Discusses limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias): YES
Conclusions Provides a general interpretation of the results in the context of other evidence, and implications for future research: YES
Funding Describes sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review: NO
APPRAISAL
- The SR presents a moderate number of limitations when assessing the items of the PRISMA statement checklist
5. Grimshaw, 2004 Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004;8(6):iii-iv, 1-72. TITEL:
Does not mention systematic review
ABSTRACT: YES
Background YES Objectives YES
Data sources YES
Study elegibility criteria
YES
Participants YES
Interventions YES
Study appraisal and synthesis methods
YES
Review methods YES
Limitations YES
Results YES
Conclusion YES
Implications of key findings
YES
Systematic review registration number NO INTRODUCTION
The explicit rationale for the interventions and rationale for the review is provided: YES
Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS): YES METHODS
Protocol and registration
Indicates if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provides a registration information including registration number: NO
Eligibility criteria Specifies study characteristics (e.g., PICOS, length of follow up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale: YES
Information sources Describes all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched: YES
Search Presents full electronic search strategy for at least one database, including any limits used, such that it could be repeated: YES
18 Academic Detailing – Supplement KCE Reports 125
Study selection State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta analysis): YES
Data collection process
Describes method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators: YES
Data items Lists and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made: YES
Risk of bias in individual
studies
Describes methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis: NO
Summary measures States the principal summary measures (e.g., risk ratio, difference in means): YES Synthesis of results Describes the methods of handling data and combining results of studies, if done, including
measures of consistency (e.g., I2 ) for each meta analysis: NA Risk of bias across studies
Specifies any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies): NA
Additional analyses Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre specified: NO
RESULTS
Study selection Gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram: NO, no flow diagram
Study characteristics For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations: YES
Risk of bias within studies Present data on risk of bias of each study and, if available, any outcome level assessment: NO Results of individual studies
For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot: NO
Synthesis of results Presents results of each meta-analysis done, including confidence intervals and measures of consistency: NA
Risk of bias across studies
Presents results of any assessment of risk of bias across studies: NO
Additional analysis Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression: NO
DISCUSSION
Summary of evidence Summarizes the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers): YES
Limitations Discusses limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias): YES
Conclusions Provides a general interpretation of the results in the context of other evidence, and implications for future research: YES
Funding Describes sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review: NO
APPRAISAL
- The SR presents a moderate number of limitations when assessing the items of the PRISMA statement checklist
KCE Reports 125 Academic Detailing – Supplement 19
6. KROENKE, 2000 Kroenke, K, Taylor-Vaisey A, Dietrich A, Oxman T. Interventions to improve provider diagnosis and treatment of mental disorders in primary care. Psychosomatics 41:1, 39-52. TITEL:
Does not mention systematic review
ABSTRACT
Background NO Objectives YES Data sources YES Study elegibility criteria YES Participants YES Interventions YES Study appraisal and synthesis methods NO Review methods NO Limitations NO Results YES Conclusion YES Implications of key findings NO Systematic review registration number NO INTRODUCTION
The explicit rationale for the interventions and rationale for the review is provided: YES
Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS): YES METHODS
Protocol and registration
Indicates if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provides a registration information including registration number: NO
Eligibility criteria Specifies study characteristics (e.g., PICOS, length of follow"up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale: YES
Information sources Describes all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched: YES
Search Presents full electronic search strategy for at least one database, including any limits used, such that it could be repeated: NO
Study selection State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta"analysis): YES
Data collection process
Describes method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators: YES
Data items Lists and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made: YES
Risk of bias in individual
studies
Describes methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis: NO
Summary measures States the principal summary measures (e.g., risk ratio, difference in means): NO Synthesis of results Describes the methods of handling data and combining results of studies, if done, including
measures of consistency (e.g., I2 ) for each meta"analysis: NO Risk of bias across studies
Specifies any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies):NO
Additional analyses Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre"specified: NA
RESULTS
Study selection Gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram: YES, but no flow diagram
Study characteristics For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations: YES
Risk of bias within studies Present data on risk of bias of each study and, if available, any outcome level assessment: NO
20 Academic Detailing – Supplement KCE Reports 125
Results of individual studies
For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot: NO
Synthesis of results Presents results of each meta-analysis done, including confidence intervals and measures of consistency: NA
Risk of bias across studies
Presents results of any assessment of risk of bias across studies: NO
Additional analysis Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression: NO
DISCUSSION
Summary of evidence Summarizes the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers): YES
Limitations Discusses limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias): NO
Conclusions Provides a general interpretation of the results in the context of other evidence, and implications for future research: YES
Funding Describes sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review: NO
APPRAISAL
- The SR presents a moderate number limitations when assessing the items of the PRISMA statement checklist
7. LU, 2008 Lu CY, Ross-Degnan D, Soumerai SB, Pearson S-A. Interventions designed to improve the quality and efficiency of medication use in managed care: a critical review of the literature - 2001-2007. BMC Health Services Research. 2008;8(75). TITEL:
Does not mention systematic review
ABSTRACT
Background YES Objectives YES
Data sources YES
Study elegibility criteria
YES
Participants YES
Interventions YES
Study appraisal and synthesis methods
YES
Review methods YES
Limitations YES
Results YES
Conclusion YES
Implications of key findings
YES
Systematic review registration number NO INTRODUCTION
The explicit rationale for the interventions and rationale for the review is provided: YES
Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS): YES METHODS
Protocol and registration
Indicates if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provides aregistration information including registration number: NO
Eligibility criteria Specifies study characteristics (e.g., PICOS, length of follow"up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale: YES
Information sources Describes all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched: YES
Search Presents full electronic search strategy for at least one database, including any limits used, such that it could be repeated: YES
KCE Reports 125 Academic Detailing – Supplement 21
Study selection State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta"analysis): YES
Data collection process
Describes method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators: YES
Data items Lists and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made: YES
Risk of bias in individual
studies
Describes methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis: NO
Summary measures States the principal summary measures (e.g., risk ratio, difference in means): YES Synthesis of results Describes the methods of handling data and combining results of studies, if done, including
measures of consistency (e.g., I2 ) for each meta"analysis: NO Risk of bias across studies
Specifies any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies): NO
Additional analyses Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre"specified: NO
RESULTS
Study selection Gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram: YES, no flow diagram
Study characteristics For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations: NO
Risk of bias within studies Present data on risk of bias of each study and, if available, any outcome level assessment: NO Results of individual studies
For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot: NO
Synthesis of results Presents results of each meta-analysis done, including confidence intervals and measures of consistency: NA
Risk of bias across studies
Presents results of any assessment of risk of bias across studies: NO
Additional analysis Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression: NO
DISCUSSION
Summary of evidence Summarizes the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers): YES
Limitations Discusses limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias): YES
Conclusions Provides a general interpretation of the results in the context of other evidence, and implications for future research: YES
Funding Describes sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review: YES
APPRAISAL
- The SR presents a limited limitations when assessing the items of the PRISMA statement checklist
22 Academic Detailing – Supplement KCE Reports 125
8. MORRISON, 2000 Morrison A, Wertheimer AI, Berger ML. Interventions to improve antihypertensive drug adherence: A quantitative review of trials. Formulary. 2000;35(3):234-45. TITEL:
Mentions systematic review
ABSTRACT
Background NO Objectives YES Data sources YES Study elegibility criteria YES Participants YES Interventions YES Study appraisal and synthesis methods NO Review methods NO Limitations NO Results YES Conclusion YES Implications of key findings NO Systematic review registration number NO INTRODUCTION
The explicit rationale for the interventions and rationale for the review is provided: YES
Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS): YES METHODS
Protocol and registration
Indicates if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provides a registration information including registration number: NO
Eligibility criteria Specifies study characteristics (e.g., PICOS, length of follow"up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale: YES
Information sources Describes all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched: YES
Search Presents full electronic search strategy for at least one database, including any limits used, such that it could be repeated: NO
Study selection State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta"analysis): YES
Data collection process
Describes method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators: YES
Data items Lists and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made: YES
Risk of bias in individual
studies
Describes methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis: NO
Summary measures States the principal summary measures (e.g., risk ratio, difference in means): NO Synthesis of results Describes the methods of handling data and combining results of studies, if done, including
measures of consistency (e.g., I2 ) for each meta"analysis: NO Risk of bias across studies
Specifies any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies): NO
Additional analyses Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre"specified: NO
RESULTS
Study selection Gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram: YES, No flow diagram
Study characteristics For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations: NO
Risk of bias within studies Present data on risk of bias of each study and, if available, any outcome level assessment: NO
KCE Reports 125 Academic Detailing – Supplement 23
Results of individual studies
For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot: NO
Synthesis of results Presents results of each meta-analysis done, including confidence intervals and measures of consistency: NA
Risk of bias across studies
Presents results of any assessment of risk of bias across studies: NO
Additional analysis Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression: NO
DISCUSSION
Summary of evidence Summarizes the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers): YES
Limitations Discusses limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias): YES
Conclusions Provides a general interpretation of the results in the context of other evidence, and implications for future research: YES
Funding Describes sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review: NO
APPRAISAL
- The SR presents a moderate number of limitations when assessing the items of the PRISMA statement checklist
9. O’BRIEN, 2007 O'Brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard-Jensen J, Kristoffersen DT, et al. Educational outreach visits: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews. 2007;-(4). TITEL:
Mentions systematic review
ABSTRACT
Background YES Objectives YES
Data sources YES
Study elegibility criteria
YES
Participants YES
Interventions YES
Study appraisal and synthesis methods
YES
Review methods YES
Limitations YES
Results YES
Conclusion YES
Implications of key findings
YES
Systematic review registration number
YES
INTRODUCTION
The explicit rationale for the interventions and rationale for the review is provided: YES
Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS): YES METHODS
Protocol and registration
Indicates if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provides aregistration information including registration number:
Eligibility criteria Specifies study characteristics (e.g., PICOS, length of follow"up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale: YES
Information sources Describes all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched: YES
Search Presents full electronic search strategy for at least one database, including any limits used, such that it could be repeated: YES
Study selection State the process for selecting studies (i.e., screening, eligibility, included in systematic review,
24 Academic Detailing – Supplement KCE Reports 125
and, if applicable, included in the meta"analysis): YES Data collection process
Describes method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators: YES
Data items Lists and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made: YES
Risk of bias in individual
studies
Describes methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis: YES
Summary measures States the principal summary measures (e.g., risk ratio, difference in means): YES Synthesis of results Describes the methods of handling data and combining results of studies, if done, including
measures of consistency (e.g., I2 ) for each meta"analysis: YES Risk of bias across studies
Specifies any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies): YES
Additional analyses Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre"specified: YES
RESULTS
Study selection Gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram: YES
Study characteristics For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations: YES
Risk of bias within studies Present data on risk of bias of each study and, if available, any outcome level assessment: YES Results of individual studies
For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot: YES
Synthesis of results Presents results of each meta-analysis done, including confidence intervals and measures of consistency: YES
Risk of bias across studies
Presents results of any assessment of risk of bias across studies: YES
Additional analysis Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression: YES
DISCUSSION
Summary of evidence Summarizes the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers): YES
Limitations Discusses limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias): YES
Conclusions Provides a general interpretation of the results in the context of other evidence, and implications for future research: YES
Funding Describes sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review: YES
APPRAISAL
- The SR presents very few limitations when assessing the items of the PRISMA statement checklist
10. OSTINI, 2009 Ostini R, Hegney D, Jackson C, Williamson M, Mackson JM, Gurman K, et al. Systematic review of interventions to improve prescribing. Ann.Pharmacother. 2009;43(3):502-13.
TITEL:
Mentions systematic review
ABSTRACT
Background YES Objectives YES
Data sources YES
Study elegibility criteria
YES
Participants YES
Interventions YES
Study appraisal and synthesis methods
YES
Review methods YES
Limitations YES
KCE Reports 125 Academic Detailing – Supplement 25
Results YES
Conclusion YES
Implications of key findings
YES
Systematic review registration number INTRODUCTION
The explicit rationale for the interventions and rationale for the review is provided: YES
Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS): YES METHODS
Protocol and registration
Indicates if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provides aregistration information including registration number: NO
Eligibility criteria Specifies study characteristics (e.g., PICOS, length of follow"up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale: YES
Information sources Describes all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched: YES
Search Presents full electronic search strategy for at least one database, including any limits used, such that it could be repeated: NO
Study selection State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta"analysis): YES
Data collection process
Describes method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators: YES
Data items Lists and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made: YES
Risk of bias in individual
studies
Describes methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis: NO
Summary measures States the principal summary measures (e.g., risk ratio, difference in means): NO Synthesis of results Describes the methods of handling data and combining results of studies, if done, including
measures of consistency (e.g., I2 ) for each meta"analysis: NO Risk of bias across studies
Specifies any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies): NO
Additional analyses Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre"specified: NO
RESULTS
Study selection Gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram: YES
Study characteristics For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations: YES
Risk of bias within studies Present data on risk of bias of each study and, if available, any outcome level assessment: NO Results of individual studies
For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot: YES
Synthesis of results Presents results of each meta-analysis done, including confidence intervals and measures of consistency: NO
Risk of bias across studies
Presents results of any assessment of risk of bias across studies: NO
Additional analysis Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression: NO
DISCUSSION
Summary of evidence Summarizes the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers): YES
Limitations Discusses limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias): YES
Conclusions Provides a general interpretation of the results in the context of other evidence, and implications for future research: YES
Funding Describes sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review: NO
APPRAISAL
26 Academic Detailing – Supplement KCE Reports 125
- The SR presents a moderate number of limitations when assessing the items of the PRISMA statement checklist.
11. PEARSON, 2003 Pearson SA, Ross-Degnan D, Payson A, Soumerai SB. Changing medication use in managed care: a critical review of the available evidence. Am J Manag Care. 2003;9(11):715-31. TITEL:
Mentions a critical review of the literature
ABSTRACT
Background NO Objectives YES Data sources YES
Study elegibility criteria
YES
Participants YES
Interventions YES
Study appraisal and synthesis methods
YES
Review methods YES
Limitations YES
Results YES
Conclusion YES
Implications of key findings
YES
Systematic review registration number NO INTRODUCTION
The explicit rationale for the interventions and rationale for the review is provided: YES
Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS): YES METHODS
Protocol and registration
Indicates if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provides a registration information including registration number: NO
Eligibility criteria Specifies study characteristics (e.g., PICOS, length of follow"up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale: YES
Information sources Describes all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched: YES
Search Presents full electronic search strategy for at least one database, including any limits used, such that it could be repeated: YES
Study selection State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta"analysis): YES
Data collection process
Describes method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators: YES
Data items Lists and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made: YES
Risk of bias in individual
studies
Describes methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis: YES
Summary measures States the principal summary measures (e.g., risk ratio, difference in means): YES Synthesis of results Describes the methods of handling data and combining results of studies, if done, including
measures of consistency (e.g., I2 ) for each meta"analysis: YES Risk of bias across studies
Specifies any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies): NO
Additional analyses Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre"specified: NO
RESULTS
Study selection Gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram: YES
Study characteristics For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations: YES
KCE Reports 125 Academic Detailing – Supplement 27
Risk of bias within studies Present data on risk of bias of each study and, if available, any outcome level assessment: NO Results of individual studies
For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot: YES
Synthesis of results Presents results of each meta-analysis done, including confidence intervals and measures of consistency: NO
Risk of bias across studies
Presents results of any assessment of risk of bias across studies: NO
Additional analysis Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression: NO
DISCUSSION
Summary of evidence Summarizes the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers): YES
Limitations Discusses limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias): YES
Conclusions Provides a general interpretation of the results in the context of other evidence, and implications for future research: YES
Funding Describes sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review: YES
APPRAISAL
- The SR presents a limited number of limitations when assessing the items of the PRISMA statement checklist
12. SKETRIS, 2009 Sketris IS, Langille Ingram EM, Lummis HL. Strategic opportunities for effective optimal prescribing and medication management. Canadian Journal of Clinical Pharmacology/Journal Canadien de Pharmacologie Clinique. 2009;16(1):e103-25. TITEL:
Does not mention systematic review
ABSTRACT
Background YES Objectives YES
Data sources YES
Study elegibility criteria
YES
Participants YES
Interventions YES
Study appraisal and synthesis methods
YES
Review methods YES
Limitations YES
Results YES
Conclusion YES
Implications of key findings
YES
Systematic review registration number NO INTRODUCTION
The explicit rationale for the interventions and rationale for the review is provided: YES
Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS): YES METHODS
Protocol and registration
Indicates if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provides a registration information including registration number: NO
Eligibility criteria Specifies study characteristics (e.g., PICOS, length of follow"up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale: YES
Information sources Describes all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched: YES
28 Academic Detailing – Supplement KCE Reports 125
Search Presents full electronic search strategy for at least one database, including any limits used, such that it could be repeated: YES
Study selection State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta"analysis): YES
Data collection process
Describes method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators: YES
Data items Lists and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made: YES
Risk of bias in individual
studies
Describes methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis: NO
Summary measures States the principal summary measures (e.g., risk ratio, difference in means): NO Synthesis of results Describes the methods of handling data and combining results of studies, if done, including
measures of consistency (e.g., I2 ) for each meta"analysis: NO Risk of bias across studies
Specifies any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies): NO
Additional analyses Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre"specified: NO
RESULTS
Study selection Gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram: YES, but no flow diagram
Study characteristics For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations: YES
Risk of bias within studies Present data on risk of bias of each study and, if available, any outcome level assessment: YES Results of individual studies
For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot: YES
Synthesis of results Presents results of each meta-analysis done, including confidence intervals and measures of consistency: NA
Risk of bias across studies
Presents results of any assessment of risk of bias across studies: NO
Additional analysis Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression: NO
DISCUSSION
Summary of evidence Summarizes the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers): YES
Limitations Discusses limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias): YES
Conclusions Provides a general interpretation of the results in the context of other evidence, and implications for future research: YES
Funding Describes sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review: YES
APPRAISAL
- The SR presents a limited number of limitations when assessing the items of the PRISMA statement checklist
13. TU, 2002 Tu K, Davis D. Can we alter physician behavior by educational methods? Lessons learned from studies of the management and follow-up of hypertension. Journal of Continuing Education in the Health Professions. 2002;22(1):11-22. TITEL:
Does not mention systematic review
ABSTRACT
Background YES Objectives YES
Data sources YES
Study elegibility criteria
YES
Participants YES
Interventions YES
KCE Reports 125 Academic Detailing – Supplement 29
Study appraisal and synthesis methods
YES
Review methods YES
Limitations YES
Results YES
Conclusion YES
Implications of key findings
YES
Systematic review registration number NO INTRODUCTION
The explicit rationale for the interventions and rationale for the review is provided: YES
Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS): YES METHODS
Protocol and registration
Indicates if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provides a registration information including registration number: NO
Eligibility criteria Specifies study characteristics (e.g., PICOS, length of follow"up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale: YES
Information sources Describes all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched: YES
Search Presents full electronic search strategy for at least one database, including any limits used, such that it could be repeated: NO
Study selection State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta"analysis): YES
Data collection process
Describes method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators: YES
Data items Lists and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made: YES
Risk of bias in individual
studies
Describes methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis: NO
Summary measures States the principal summary measures (e.g., risk ratio, difference in means): NO Synthesis of results Describes the methods of handling data and combining results of studies, if done, including
measures of consistency (e.g., I2 ) for each meta"analysis: NO Risk of bias across studies
Specifies any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies): NO
Additional analyses Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre"specified: NO
RESULTS
Study selection Gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram: Yes, with flow diagram.
Study characteristics For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations: YES
Risk of bias within studies Present data on risk of bias of each study and, if available, any outcome level assessment: NO Results of individual studies
For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot: NO
Synthesis of results Presents results of each meta-analysis done, including confidence intervals and measures of consistency: NO
Risk of bias across studies
Presents results of any assessment of risk of bias across studies: NO
Additional analysis Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression: NO
DISCUSSION
Summary of evidence Summarizes the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers): YES
Limitations Discusses limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias): YES
Conclusions Provides a general interpretation of the results in the context of other evidence, and
30 Academic Detailing – Supplement KCE Reports 125
implications for future research: YES
Funding Describes sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review: YES
APPRAISAL
- The SR presents some limitations when assessing the items of the PRISMA statement checklist
14. WEINMANN, 2007 Weinmann S, Koesters M, Becker T. Effects of implementation of psychiatric guidelines on provider performance and patient outcome: systematic review. Acta Psychiat Scnad 2007: 115, 420-433. TITEL:
Mentions systematic review ABSTRACT
Background NO Objectives YES Data sources YES Study elegibility criteria YES Participants YES Interventions YES Study appraisal and synthesis methods NO Review methods NO Limitations NO Results YES Conclusion YES Implications of key findings NO Systematic review registration number NO INTRODUCTION
The explicit rationale for the interventions and rationale for the review is provided: YES
Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS): YES METHODS
Protocol and registration
Indicates if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provides aregistration information including registration number: NO
Eligibility criteria Specifies study characteristics (e.g., PICOS, length of follow"up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale: YES
Information sources Describes all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched: YES
Search Presents full electronic search strategy for at least one database, including any limits used, such that it could be repeated: NO
Study selection State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta"analysis): YES
Data collection process
Describes method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators: Yes
Data items Lists and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made: YES
Risk of bias in individual
studies
Describes methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis: NO
Summary measures States the principal summary measures (e.g., risk ratio, difference in means): NO Synthesis of results Describes the methods of handling data and combining results of studies, if done, including
measures of consistency (e.g., I2 ) for each meta"analysis: NO Risk of bias across studies
Specifies any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies): NO
Additional analyses Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre"specified: NA
KCE Reports 125 Academic Detailing – Supplement 31
RESULTS
Study selection Gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram: YES, no flow diagram
Study characteristics For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations: YES
Risk of bias within studies Present data on risk of bias of each study and, if available, any outcome level assessment: NO Results of individual studies
For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot: YES
Synthesis of results Presents results of each meta-analysis done, including confidence intervals and measures of consistency: NO
Risk of bias across studies
Presents results of any assessment of risk of bias across studies: NO
Additional analysis Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression: NO
DISCUSSION
Summary of evidence Summarizes the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers): YES
Limitations Discusses limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias): YES
Conclusions Provides a general interpretation of the results in the context of other evidence, and implications for future research: YES
Funding Describes sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review: YES
APPRAISAL
- The SR presents a moderate number of limitations when assessing the items of the PRISMA statement checklist
15. WILTON, 2002 Wilton P, Smith R, Coast J, Millar M. Strategies to contain the emergence of antimicrobial resistance: a systematic review of effectiveness and cost-effectiveness. J Health Serv Res Policy. 2002;7(2):111-7. TITEL:
Mentions systematic review ABSTRACT
Background NO Objectives YES Data sources YES Study elegibility criteria YES Participants YES Interventions YES Study appraisal and synthesis methods YES Review methods YES Limitations NO Results YES Conclusion YES Implications of key findings NO Systematic review registration number NO INTRODUCTION
The explicit rationale for the interventions and rationale for the review is provided: YES
Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS): YES METHODS
Protocol and registration
Indicates if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provides aregistration information including registration number: NO
32 Academic Detailing – Supplement KCE Reports 125
Eligibility criteria Specifies study characteristics (e.g., PICOS, length of follow"up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale: YES
Information sources Describes all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched: YES
Search Presents full electronic search strategy for at least one database, including any limits used, such that it could be repeated: YES
Study selection State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta"analysis): YES
Data collection process
Describes method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators: YES
Data items Lists and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made: YES
Risk of bias in individual
studies
Describes methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis: YES
Summary measures States the principal summary measures (e.g., risk ratio, difference in means): YES Synthesis of results Describes the methods of handling data and combining results of studies, if done, including
measures of consistency (e.g., I2 ) for each meta"analysis: YES Risk of bias across studies
Specifies any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies): YES
Additional analyses Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre"specified: NA
RESULTS
Study selection Gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram: YES, no flow diagram
Study characteristics For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations: YES
Risk of bias within studies Present data on risk of bias of each study and, if available, any outcome level assessment: YES Results of individual studies
For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot: YES
Synthesis of results Presents results of each meta-analysis done, including confidence intervals and measures of consistency: NA
Risk of bias across studies
Presents results of any assessment of risk of bias across studies: YES
Additional analysis Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression: NA
DISCUSSION
Summary of evidence Summarizes the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers): YES
Limitations Discusses limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias): YES
Conclusions Provides a general interpretation of the results in the context of other evidence, and implications for future research: YES
Funding Describes sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review: NO
APPRAISAL
- The SR presents a limited number of limitations when assessing the items of the PRISMA statement checklist
KCE Reports 125 Academic Detailing – Supplement 33
16. YEN, 2006 Yen BM. Engaging physicians to change practice. Journal of Clinical Outcomes Management. 2006;13(2):103-10. TITEL:
Does not mention systematic review
ABSTRACT
Background NO Objectives YES Data sources YES
Study elegibility criteria
YES
Participants YES
Interventions YES
Study appraisal and synthesis methods
YES
Review methods YES
Limitations YES
Results YES
Conclusion YES
Implications of key findings NO Systematic review registration number NO INTRODUCTION
The explicit rationale for the interventions and rationale for the review is provided: YES
Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS): YES METHODS
Protocol and registration
Indicates if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provides aregistration information including registration number: NO
Eligibility criteria Specifies study characteristics (e.g., PICOS, length of follow"up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale: YES
Information sources Describes all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched: YES
Search Presents full electronic search strategy for at least one database, including any limits used, such that it could be repeated: NO
Study selection State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta"analysis): YES
Data collection process
Describes method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators: YES
Data items Lists and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made: YES
Risk of bias in individual
studies
Describes methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis: NO
Summary measures States the principal summary measures (e.g., risk ratio, difference in means): NO Synthesis of results Describes the methods of handling data and combining results of studies, if done, including
measures of consistency (e.g., I2 ) for each meta"analysis: NO Risk of bias across studies
Specifies any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies): NO
Additional analyses Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre"specified: NO
RESULTS
Study selection Gives numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram: YES, but no flow diagram
Study characteristics For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations: YES
Risk of bias within studies Present data on risk of bias of each study and, if available, any outcome level assessment: NO Results of individual For all outcomes considered (benefits or harms), present, for each study: (a) simple summary
34 Academic Detailing – Supplement KCE Reports 125
studies data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot: YES
Synthesis of results Presents results of each meta-analysis done, including confidence intervals and measures of consistency: NA
Risk of bias across studies
Presents results of any assessment of risk of bias across studies: NO
Additional analysis Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression: NO
DISCUSSION
Summary of evidence Summarizes the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers): YES
Limitations Discusses limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias): YES
Conclusions Provides a general interpretation of the results in the context of other evidence, and implications for future research: YES
Funding Describes sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review: YES
Summarise key findings, interpret the results in light of totality of available evidence: describe potential biases in the review process and suggest a future research agenda: YES
APPRAISAL
- The SR presents a moderate number of limitations when assessing the items of the PRISMA statement checklist
KCE Reports 125 Academic Detailing – Supplement 35
1.3 PRIMARY STUDIES: EXCLUSION -QUALITY APPRAISAL
1.3.1 Studies excluded on the basis of full text: reason for exclusion
Number
Author Reasons for rejection
1. Bernal-delgado, 2002
This study focuses on group academic detailing only, and not on one-to-one academic detailing.
2. Blanc, 2008 This study provides no description of outcomes, and has a retrospective study design that does not allow any conclusions on the effectiveness of academic detailing.
3. Cockburn, 1992 Quality appraisal score of 5/14 4. Dolovich, 1999 This study focuses on commercially sponsored evidence-
based academic detailing, and is out of scope. 5. Font, 1991 Out of scope 6. Freemantle, 1999 This study provides no outcome data since it is a paper that
documents the rationale and design of the study 7. Grimshaw, 2001 Overview of systematic reviews--replaced to systematic reviews 8. Grimshaw, 2004 Duplicate –in list of systematic reviews 9. Grindrod, 2006 Duplicate –in list of reviews of systematic reviews 10. Horowitz, 1996 This study provides no outcome data since it describes the
project design and process of implementing an AD intervention.
11. Joseph, 2004 This study targets hospitals only 12. Magrini, 2007 This study provides no outcome data since it describes the
study protocol 13. May, 2009 This study provides no outcome data since it describes
experiences with AD only 14. Miller, 2004 This study targets hospitals only
15. Morrison, 2000 Review, newly added in listing of reviews 16. Pearson, 2003 Duplicate –put in list of systematic reviews 17. Polinski, 2005 This study provides no outcome data since it describes the
implementation of an AD program only 18. Pond, 1994 Quality appraisal score of 6/14 19. Richens, 2004 No reference available 20. Rosich, 2005 Article in Spanish 21. Skaer, 1993 Study not included since it is not clear if the intervention is
directed at hospital physicians or general practitioners 22. Solomon, 2001 This study targets a US teaching hospital only 23. Stevens, 2002 This study targets patients with AD and not physicians 24. Yeo, 1994 Study not included: describes intervention and process
evaluation—no evaluation component
36 Academic Detailing – Supplement KCE Reports 125
1.3.2 Quality appraisal of the 87 studies included
Author,year
RQ
PP/SET
INTERV
COMP
OUTCOM
DESIGN SS STAT
GEN CONF RAND BLIND CLUST DATAP TOTAL
1. Aspy, 2008 1 1 1 1 1 1 1 1 1 1 1 -1 1 1 13/14
2. Avorn, 1983 1 -1 1 1 1 1 1 1 1 1 -1 1 0 1 9/14
3. Benincasa, 1996 1 1 1 0 1 1 1 1 1 -1 0 0 0 1 8/14
4. Berings, 1994 1 1 1 1 - 1 1 1 1
1 1 -1 0 1 9/14
5. Bonds, 2009 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
6. Braybrook, 1996 1 -1 1 1 1 1 1 1 1 1 1 -1 0 1 9/14
7. Broadhurst, 2007
1 1 1 0 1 1 1 1 1 0 0 0 0 1 9/14
8. Brown, 2000 1 1 1 1 1 1 1 1 1 -1 1 1 -1 1 12/14
9. Browner, 1994 1 1 1 1 1 1 1 1 1 -1 1 0 -1 1 11/14
10. Coenen, 2004 1 1 1 1 1 1 1 1 1 1 1 -1 0 1 11/14
11. Cranney, 1999 1 1 1 1 1 1 1 1 1 0 1 -1 0 0 9/14
12. De Burgh, 1995 1 1 1 1 1 1 1 1 1 1 1 -1 0 1 11/14
13. Dey, 2004 1 1 1 1 1 1 1 1 1 1 1 -1 1 1 12/14
14.. De Santis, 1994 1 1 1 1 1 1 1 1 1 1 1 -1 0 1 9/14
15. Eccles, 2007 1 1 1 1 1 1 1 1 1 1 1 -1 0 1 11/14
16. Epstein, 2008 1 1 1 0 1 1 -1 1 1 0 0 0 0 1 7/14
17. Etter, 2006 1 1 1 1 1 1 1 1 1 0 1 -1 0 0 9/14
18. Feder, 1995 1 1 1 1 1 1 1 1 1 1 1 -1 0 1 11/14
19. Feldstein, 2006 1 1 1 0 1 1 1 1 1 0 0 0 0 1 9/14
20. Figueiras, 2001 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
21. Figueiras, 2006 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
22. Franzini, 2007 1 1 1 1 1 1 -1 1 1 -1 1 -1 0 1 7/14
23. Freemantle, 2002
1 1 1 1 1 1 1 1 1 1 1 1 0 0 12/14
24. Fretheim, 2006 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
25. Fretheim, 2006 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
26. Frijling, 2003 1 1 1 1 1 1 1 1 1 1 1 -1 0 1 11/14
27. Gandjour, 2005 - - - - - - - - - - - - - - NA since cost study
KCE Reports 125 Academic Detailing – Supplement 37
28. Goldberg, 1998 1 1 1 1 1 1 1 1 1 1 1 0 0 1 12/14
29. Gomel, 1998 1 1 1 1 1 1 1 1 1 0 1 -1 0 1 10/14
30. Gonzales, 1999 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
31. Graham, 2008 1 1 1 1 1 1 1 1 1 1 0 0 0 1 11/14
32. Griffiths, 2004 1 1 1 1 1 1 1 1 1 1 1 1 1 1 12/14
33. Hall, 2001 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
34. Hennessy, 2006 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
35. Horn, 2007 1 1 1 1 1 1 1 1 1 0 0 0 0 1 10/14
36. Hulsher, 1997 1 1 1 1 1 1 -1 1 1 0 0 1 1 1 11/14
37. Ilett, 2000 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
38. Jackson, 2004 1 1 1 1 1 1 1 1 1 -1 0 1 0 1 11/14
39. Kim, 1999 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
40. Lemelin, 2001 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
41. Lin, 1997 1 1 1 0 1 1 1 1 1 0 0 1 0 1 10/14
42. Lin, 2001 1 1 1 1 1 1 1 1 1 0 1 1 0 1 12/14
43. Lobo, 2002 1 1 1 1 1 1 1 1 1 0 1 1 0 1 12/14
44. Lobo, 2002 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
45. Manfredi, 1998 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
46. Mason, 2001 - - - - - - - - - - - - - - NA since cost study
47. McDonald, 2003 1 1 1 0 1 1 -1 1 1 0 0 0 0 1 7/14
48. Midlov, 2006 1 1 1 1 1 1 1 1 1 -1 1 1 0 1 11/14
49. Mold, 2008 1 1 1 1 1 1 -1 1 1 -1 1 1 0 1 9/14
50. Meyers, 2004 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
51. Naughton, 2007 1 1 1 1 1 1 1 1 1 1 1 1 1 1 14/14
52. New, 2004 1 1 1 1 1 1 1 1 1 1 1 1 1 1 14/14
53. Newton-Syms, 1992
1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
54. Nilsson, 2001 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
55. Ofman, 2003 1 1 1 1 1 1 1 1 1 1 1 1 1 1 14/14
56. Ornstein, 2004 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
57. Paton, 2008 1 1 1 0 1 1 1 1 1 0 0 0 0 1 9/14
58. Peterson, 1996 1 1 1 1 1 1 -1 1 1 -1 0 1 0 1 8/14
59. Peterson, 1997 1 1 1 1 1 1 1 1 1 -1 0 1 0 1 10/14
38 Academic Detailing – Supplement KCE Reports 125
60. Pit, 2007 1 1 1 1 1 1 1 1 1 1 1 1 1 1 14/14
61. Raisch, 1990 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
62. Ray, 1985 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
63. Ray, 1986 1 1 1 1 1 1 1 1 1 -1 -1 1 0 1 9/14
64. Ricordeau, 2003 1 1 1 1 1 1 1 1 1 -1 0 0 0 1 9/14
65. Schuster, 2008 1 1 1 1 1 1 1 1 1 1 0 0 0 1 11/14
66. Schaffner, 1983 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
67. Shanahan, 2006 1 1 1 1 1 1 1 1 1 0 0 0 0 1 10/14
68. Siegel, 2003 1 1 1 0 1 1 1 1 1 0 1 0 0 1 10/14
69. Simon, 2005 1 1 1 1 1 1 1 1 1 1 1 1 1 1 14/14
70. Simon, 2007 1 1 1 1 1 1 1 1 1 1 1 1 1 1 14/14
71. Siriwardena, 2002
1 1 1 1 1 1 1 1 1 1 1 -1 0 1 12/14
72. Sheinfeld, 2000 1 1 1 1 1 1 1 1 1 0 0 0 0 1 10/14
73. Stone, 2005
- - - - - - - - - - - - - - NA since cost study
74. Teng, 2006 1 1 1 1 1 1 -1 1 1 0 0 0 0 1 8/14
75. Turner, 2000 1 1 1 1 1 1 -1 1 1 -1 1 1 0 1 9/14
76. Varonen, 2007 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
77. Van den Hombergh, 1999
1 1 1 1 1 1 1 1 1 1 1 -1 0 1 12/14
78 Van der Wijden, 1999
1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
79. Van Eijk, 2001 1 1 1 1 1 1 1 1 1 1 1 -1 0 1 13/14
80. Walsh, 2005 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
81. Watson, 2001 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
82. Weller, 2003 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
83. Williams, 1994 1 1 1 0 1 1 0 1 1 0 0 0 0 1 8/14
84. Witt, 2004 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
85. Wong, 2004 1 1 1 1 1 1 1 1 1 -1 1 1 0 1 12/14
86. Young, 2002 1 1 1 1 1 1 1 1 1 1 1 1 0 1 13/14
87. Zwar, 2000 1 1 1 1 1 1 1 1 1 1 1 -1 0 1 12/14
39 Academic Detailing – Supplement KCE Reports 125
1.3.3 Elements used to describe the studies on academic detailing
Item Definition 1. Country Place were the study was conducted including countries in Europe, U.S.,
Australia and Asia. 2. Initiator of the program Is the person or organisational entity which has initiated and/or funded the
programme 3. Type of research design
The research design refers to RCT, before-after study,..
4. Type of objectives
Goals of studies including academic detailing include improvements in processes and outcomes of care.
5. Setting The setting refers to the type of health care setting (physician’s office, primary care clinics,….)
6. Type and number of populations targeted
The type of population refers to patients with cancer, heart failure, diabetes, neurodegenerative diseases, respiratory diseases,…
7. Type and number of caregivers targeted
Caregivers targeted refer to individual professionals or groups of care providers.
8. Type of behaviour targeted The behaviour targeted refers to prescription behaviour, adherence to guidelines and any other behaviour related to quality/outcomes of care.
9. Type and number of professionals responsible for providing academic detailing
Professionals responsible for academic detailing are individuals who have been trained to provide the service
10. Type, number and intensity of interventions
Interventions refer to all actions that are defined as academic detailing
11. Academic detailing part of multifaceted intervention programme
A multifaceted intervention programme consists of a least out of one additional intervention besides academic detailing.
12. Type of outcome measures/indicators Outcome measures refer to measurable items of care which focus upon some aspects of structure, process (clinical or inter-personal) or outcome and for which there is evidence or consensus that it can be used to assess the quality of care provided, and hence change it. These include biological outcomes, process outcomes, psycho-social outcomes and economic outcomes.
13. (Cost)effectiveness
(Cost)effectiveness is defined in this review as the degree to which the financial objectives of a program, care, service or system are achieved.
40 Academic Detailing – Supplement KCE reports 125
1.4 OVERVIEW OF THE SELECTED PAPERS
1.4.1 Description of the reviews of reviews Number Author, date Main research question Databases (years) Exclusion (E) / inclusion criteria (I) Selected systematic reviews 1. Bloom, 2005{Bloom, 2005
#2} Effect of continuing medical education on physician clinical care and patient health
Medical literature analysis and retrieval system on-line, DARE, Cochrane, Cinahl, Excerpta Medica database, Psychinfo, Canadian Medical Association Infobase, National Guidelines Clearinghouse, evidence-based medicine review, American College of Physicians Journal Club, HealthSTAR (1/1/1984 – 30/10/2004)
(I) English-language peer-reviewed journals (I) Formal meta-analysis or other structured review (E) literature reviews alone
Morrison et al, 2000 Thomson O’Brien et al. 2000 Thomson O’Brien et al. 2001
2. Grindrod et al, 2006{Grindrod, 2006 #7}
Interventions of pharmacists to impact health practitioners’ prescribing practices
Medline, Cinahl, Embase, Cochrane (! July 2005)
(I) English-languages SR (I) clear report of search strategy, inclusion/exclusion criteria, assessment criteria and methods for synthesizing or summarizing information and references
Grimshaw al, 2004 Harvey et al, 2002 Pearson et al. 2003 Thomson O’Brien et al. 2000 Wilton et al., 2002
3. Landry et al,2002{Landry, 2002 #9}
Changing physician behaviour (critical safety care medicine)
Medline, Psychinfo, ABI/INFORM, O-INSPEC
(I) controlled observational studies, clinical trials and systematic reviews, relevant non-health care literature, gray literature
Thomson O’Brien et al. 2000
4. Satterlee et al, 2008{Satterlee, 2008 #15}
Effective medical education Cochrane database of systematic review (issue 4 for 2006)
- Thomson O’Brien et al. 2000
5. Sohn et al, 2004{Sohn, 2004 #17}
Efficacy of educational interventions targeting primary care provider’s practice behaviours (dental care)
Medline, Cochrane (January 1988-March 2003)
(I) Following a list of interventions (I) Outcome measures described (I) quality of reporting (QUORUM) (I) RCT, CCT, CBA, ITS (I) English-language
Thomson O’Brien et al. 2000
KCE Reports 125 Academic Detailing – Supplement 41
1.4.2 Selected systematic reviews and source articles in these reviews Number Author, date Main research question Databases (years) Exclusion (E) / inclusion
criteria (I) Final decision (inclusion of the review?)
Selected source articles (individual studies) on academic detailing / outreach visits
1. Arnold et al, 2005{Arnold, 2005 #1}
Interventions to improve antibiotics prescribing practices in ambulatory care
Medline, Embase + EPOC search strategy (! May 2000)
(I) RCT, QRCT, CBA, ITC (II) primary care in
outpatients settings (III) professional intervention (IV) patient-based
interventions (I) English language articles
Included Avorn, 1983 De Santis 1994 Dolovich, 1999 Font, 1991 Ilett, 2000 Peterson, 1997 Shaffner 1983 Ray 1985
2. Chaillet et al, 2006{Chaillet, 2006 #3}
Strategies for implementing clinical practice guidelines in obstetric care
Cochrane, Medline, Embase (January 1990 – June 2005)
(V) RCT, CBA, ITC (VI) quality criteria (EPOC) (E) non obstetrics, no relation to clinical guidelines implementation, opinion letters, no patient data, n patients<100 or health professional<75%, qualitative studies
Included Richens, 2004
3. Fish et al, 2002{Fish, 2002 #4}
Practice-based pharmaceutical services Medline, Embase (2001-2007)
(I) RCTs, CCTs (II) Publication date after 1980 (III) English language
Conducted in the UK, Australia, Canada, Scandinavia or the US
Included Avorn, 1983 Braybrook, 1996 De Santis 1994 Ilett, 2000 Newton-Syms, 1992 Watson, 2001 Solomon, 2001
4. Fendrick et al 2001 Effectiveness of benefit based co payment
------ ------ Excluded -----
5. Grimshaw, 2001{Grimshaw, 2001 #5}
Effectiveness and costs of different guideline development, dissemination and implementation
Medline, Healthstar, Cochrane controlled trial register, Embase, Sigle, Cochrane EPOC specialised register
Included Browner, 1994 De Burgh, 1995 De Santis, 1994 Feder, 1995 Hulsher, 1997 Manfredi, 1998
42 Academic Detailing – Supplement KCE reports 125
Number Author, date Main research question Databases (years) Exclusion (E) / inclusion criteria (I)
Final decision (inclusion of the review?)
Selected source articles (individual studies) on academic detailing / outreach visits Morrison, 1999 I Ornstein, 1991
6. Grimshaw al, 2004{Grimshaw, 2004 #6}
Effectiveness and costs of different guideline development, dissemination and implementation
Medline, Healthstar, Cochrane controlled trial register, Embase, Sigle, Cochrane EPOC specialised register
(VII) RCT, CCT, CBA, ITC participants: medically qualified healthcare professionals
outcomes: objective measures of provider behaviour and/or patient outcome
Included Browner, 1994 De Burgh, 1995 De Santis, 1994 Feder, 1995 Hulsher, 1997 Manfredi, 1998 Morrison, 1999 I Ornstein, 1991 Peterson, 1996 Raisch, 1990 Ray, 1986 Ray,1987 Soumerai, 1987 Van der Weijden, 1999
7. Harvey et al, 2002 Interventions to improve health professionals’ management of obesity
Medline, psyclit, Embase, Sigle, Sociofile, dissertation Abstracts, Conference Paêrs Index, Cochrane
(I)scope (X) RCT, CCT, CBA, ITS
qualified health professionals, overweight and/or obese patients
interventions according to EPOC criteria (I) outcome measure: provider performance or patients outcomes
Excluded No articles selected
8. Kroenke et al, 2000{Kroenke, 2000 #8}
Interventions to improve provider diagnosis and treatment of mental disorders in primary care
(I)scope (XIII) RCT, CCT, CBA, ITS qualified health professionals, overweight and/or obese patients; interventions according to EPOC criteria (I) outcome measure: provider performance or patients outcomes
Included Goldberg, 1998
9. Lu et al, 2008{Lu, 2008 #10} Interventions to improve the quality and the efficiency of medication use in managed care
Medline, Embase (2001-2007)
(I) publication between July 2001 and January 2007 (I) related to the research
Included Simon, 2005 Soumerai, 1990 Stevens, 2002
KCE Reports 125 Academic Detailing – Supplement 43
Number Author, date Main research question Databases (years) Exclusion (E) / inclusion criteria (I)
Final decision (inclusion of the review?)
Selected source articles (individual studies) on academic detailing / outreach visits
question (E) clinical effectiveness trials, cost-effectiveness studies of medications, descriptive studies, vaccination studies (I) RCT, CBA, ITS with at least 20 subjects in each comparison group
10. Morrison et al, 2000{Morrison, 2000 #11}
Effectiveness of interventions to improve oral antihypertensive drug adherence
Medline (1965- February 1999) + bibliographies scrennes
(I) English-language (I) report of parallel-group, RCT, QRCT, (I) drug adherence= study endpoint (E) n<10
Excluded No articles selected
11.
Thomson O’Brien et al. 2000 ! Update in Doumit, 2007
Out of scope Excluded No articles selected
12. Thomson O’Brien et al. 2000 - update in 2007{O’Brien, 2007 #124}
Effects of educational outreach visits on professional practice and health care outcomes
EPOC Medline Cinahl (March 2007)
(I) RCT (I) healthcare professionals
responsible for patient care (E) students (I) outcome: performance in a healthcare setting or healthcare outcome
Included Avorn, 1983 Berings, 1994 Braybrook, 1996 Cockburn, 1992 Coenen, 2004 De Burgh, 1995 Dey, 2004 Feder, 1995 Figuieras, 2001 Figuieras, 2006 Font, 1991 Freemantle, 2002 Fretheim, 2006 Frijling, 2003 Griffiths, 2004 Hall, 2001 Hennessy, 2006 Ilett, 2000 Kim, 1999 Lemelin, 2001 Myers, 2004 New, 2004 Newton-Syms, 1992 Ofman, 2003
44 Academic Detailing – Supplement KCE reports 125
Number Author, date Main research question Databases (years) Exclusion (E) / inclusion criteria (I)
Final decision (inclusion of the review?)
Selected source articles (individual studies) on academic detailing / outreach visits Ornstein, 2004 Raisch, 1990 Simon, 2005 Siriwardena, 2002 Van der Weijden, 1999 Van Eijk, 2001 Vanden Hombergh, 1999 Walsh, 2005 Watson, 2001} Weller, 2003 Witt, 2004 Young, 2002 Zwar, 2000
13. O’Brien et al. 2001 ! Update In Forsetlund 2009
Excluded No articles selected
14. Ostini, 2009
Interventions to improve prescribing Pubmed, EMBASE (1974-2008)
Experimental and quasi-experimental research studies
Included Horn, 2007 Jackson, 2004 Naughton, 2007
15. Pearson et al. 2003{Pearson, 2003 #14}
Effectiveness of strategies to improve quality and efficiency of medication use in managed care
Medline, Healthstar, Current content, Cochrane, Embase, ASI, IPA, International Network for Rational Use of Drugs (INRUD)
RCT, pre-post studies (with statistical test differences between groups), ITS (I) n>20
Included Brown, 2000
16. Sketris et al, 2009{Sketris, 2009 #16}
Effective optimal prescribing and medication management
PubMed, Cinahl, Embase, Ineternational pharmaceutical abstract (1995-2006) + google, google scholar, New York Academy of Medicine Library Grey literature report + Cochrane, Canadian Agency for Drugs and Technologies in Health
(E) non English language (E) behavioural and system change theory
Included Coenen, 2004 Eccles, 2007 Freemantle, 1999 Freemantle, 2002 Graham, 2007 Graham, 2008 Mason,2001 Solomon, 2001
17. Tu et al, 2002{Tu, 2002 #18} Educational methods to manage and follow hypertension
Medline Cochrane, research and development resource
(I) RCT with >50% physician involvement, measure of physician behaviour change or patient
Included Goldberg, 1998
KCE Reports 125 Academic Detailing – Supplement 45
Number Author, date Main research question Databases (years) Exclusion (E) / inclusion criteria (I)
Final decision (inclusion of the review?)
Selected source articles (individual studies) on academic detailing / outreach visits
base in continuing education (University of Toronto) (1966-2000)
outcomes , physician or patient dropout<30%¨+follow-up of outcome > 30 days
18. Weinmann et al, 2007{Weinmann, 2007 #19}
Effects of implementation of psychiatric guidelines on provider performance and patient outcome
Included Brown, 2000 Goldberg, 1998 Joseph, 2004 Miller, 2004
19. Wilton et al., 2002{Wilton, 2002 #20}
Strategies to contain the emergence of antimicrobial resistance – effectiveness and cost-effectiveness
Medline (1960-2000) ISI (1981-2000) Embase (1988-2000) DARE and CRD OPAC (1975-2000) Cochrane (1990-2000)
(I) economic evaluations, cost /-effectiveness studies,
Included Gonzales, 1999 Skaer, 1993
20. Yen et al, 2006{Yen, 2006 #21}
Strategies to influence physician behaviour
Medline, Cochrane (?-?) (I) meta-analyses, systematic reviews, RCT
Included Grimshaw, 2001 Grimshaw, 2004 Pearson, 2003
RCT: Randomized Controlled Trials – QRCT: Quasi Randomized Controlled Trials – CCT: Controlled Clinical Trials - CBA: Controlled Before and After studies – ITS: Interrupted Time Series – EPOC: Effective Practice and Organisation of Care Group. B: book – D: dissertation – R: report
46 Academic Detailing – Supplement KCE reports 125
1.4.3 Overview of the 87 studies on academic detailing. Author,year
Design Country
Population
Behavior targeted
Who does AD
Multifaceted intervention
Outcomes
Effectiveness
1. Aspy, 2008 {Aspy, 2008 #24}
RCT US
Healthy woman age > 50y
Prescribing of mammography
Detailer, not specified
YES Process outcomes: rates of mammography prescription
Positive on: rates of mammography prescription
RCT US Patients needing cerebral and peripheral vasodilators, oral cephalo-sporin and propoxy- Phene
Prescribing of three drug groups.
Pharmacist NO Process outcomes: use of three drug groups: cerebral and peripheral vasodilators, an oral cephalosporin and propoxyphene.
Positive on: Significant reductions in the number of target drugs in intervention group compared to control group + cost reductions
3. Benincasa, 1996 {Benincasa, 1996 #26}
Before-after study US
Patients with cancer
CBE and lump-detection skills in physicians.
Physician experts
YES Process outcomes: number of lump detections
Positive on: the mean number of correct lump detections increased significantly, and the number of false positives decreased
4. Berings, 1994 {Berings, 1994 #27}
RCT Belgium
General population
Prescription of benzodiazepines
General practitioners
YES Psycho-social outcomes: attitude of physicians about the value of oral drug information from an industry-independent source Process outcomes: number of benzodiazepines prescribed per 100 patient contacts
Positive on: average decrease of 3% in control group and of 14% in physicians who received written information, and 24% in physicians who were given oral information + positive attitude towards the value of oral drug information from an industry-independent source
5. Bonds, 2009 {Bonds, 2009 #28}
RCT US
Patients with hypertension
Blood pressure control Detailer, not specified
YES Biological outcomes: medical comorbidities, blood pressure values, recommendations of therapeutic life style changes, number of blood pressure medications. Key: mean SBP and DBP Process outcomes: percent of patients at or below JNC 7 blood pressure goal; percent of patients with undiagnosed hypertension, intensification of therapy in those not at goal, and appropriate
No effect on: no difference between 2 groups in any of the adherence measures.
KCE Reports 125 Academic Detailing – Supplement 47
selection of initial therapy in those with newly diagnosed hypertension
6. Braybrook, 1996 {Braybrook, 1996 #29}
RCT US
Patients who need antibiotics
Antibiotic prescribing Pharmacist
NO Process outcomes: antibiotic prescribing indicators (= medications) Economic outcomes: Costs
Positive on: changes in antibiotic prescribing indicators were greater in intervention compared to control group + reduced costs
7. Broadhurst, 2007 {Broadhurst, 2007 #30}
Before after study Australia
People with shoulder pain
Use of diagnostic imaging for shoulder complaints in general practice and their knowledge and confidence to manage shoulder pain.
Specialist YES Process outcomes: requests for ultrasound imaging, knowledge about identifying and managing shoulder problems
Positive on: requests for ultrasound imaging decreased significantly after six months of AD + knowledge and confidence No effect on: no effect on the rate of requests over time in the control groups
8. Brown, 2000 {Brown, 2000 #31}
RCT US
Patients with depression
Management of depression Pharmacist
YES Biological outcomes: HSCL-D, receipt of depression treatment, score of SF-36 Process outcomes: clinician knowledge, attitude and practices related to the detection and treatment of depression Economic outcomes: dispensing of antidepressant medication
Positive on: number of an Antidepressants Negative on: deterioration in self-reported physical functioning and vitality, more depressive cohort patients of control physicians improved compared to patients of AD-exposed patients
9. Browner, 1994 {Browner, 1994 #32}
RCT US
Patients with high serum cholesterol levels
Management of high serum cholesterol levels
Detailer, not specified
YES Process outcomes: proportion of patients whose management complied to the NCEP guidelines = Screening for total cholesterol, determination of LDL-cholesterol, treatment of elevated LDL-cholesterol level, screening for hypercholesterolemia, treatment, follow-up for high serum cholesterol levels, measurements of HDL-cholesterol and triglyceride
No effect on: no significant differences in screening for high serum cholesterol or compliance with guidelines between the groups receiving CME and the control group. There was a trend toward a modest benefit from the CME interventions.
48 Academic Detailing – Supplement KCE reports 125
10. Coenen,
2004 {Coenen, 2004 #33}
Before-after Belgium
Patients (adults) who need antibiotics for acute cough
Prescribing of antibiotics for acute cough
Pharmacist
YES Biological outcomes: patients’ symptom resolution due to change in antibiotic prescribing Process outcomes: antibiotics prescribing rates + type of antibiotics prescribed Economic outcomes: medication cost per patient from a public perspective
Positive on: Less prescribing in intervention group + prescribed antibiotics more in line with guideline in intervention group and less expensive from public perspective No effect on: patients’ symptom resolution
11. Cranney, 1999 {Cranney, 1999 #34}
RCT UK
Elderly with hypertension
Management of systolic hypertension in the elderly (patient aged 70 to 79 years)
Researcher YES Process outcomes: management of systolic hypertension and a specific patient scenario
Positive on: significant difference in the stated threshold for treating systolic hypertension between intervention and control + difference in the willingness to treat patient (case) with mild hypertension
12. De Burgh, 1995 {de Burgh, 1995 #35}
RCT Australia
Patients with anxiety
Precribing of benzodiazepine in patients with anxiety
Pharmacist and physician
NO Process outcomes: benzodiazepine prescribing rate, axiety and insomnia diagnosis rates
Positive on: when comparing the intervention arms, benzodiazepine prescribing rate, axiety and insomnia diagnosis rates declined significantly, also initial prescription rates, differential downward trend in c per insomnia diagnosis, but not to a statistical level. No effect on: prescribing for anxiety diagnosis.
13. Dey, 2004 {Dey, 2004 #37}
RCT UK
Patients (adults) with low back pain
Management of low back pain in adults
Senior representatives, health authority
YES Process outcomes: rate of referral for lumbar spine X-rays, issuing of sickness certification, referral to secondary care and prescription of muscle relaxants and opioid analgesics.
Positive on: significant differences between study groups for referral to physiotherapists or the back pain unit No effect on: no significant differences between study groups in proportion of patients who were referred for X-ray, issued with a sickness certificate, prescribed opioids or muscle relaxants, or were referred to secondary care.
KCE Reports 125 Academic Detailing – Supplement 49
14 De Santis, 1994 {De Santis, 1994 #36}
RCT Australia
Patients (adults) who need antibiotics for tonsillitis
Prescribing of antibiotics for tonsillitis.
Pharmacist
YES Process outcomes: the percentage of prescriptions of antibiotics for tonsillitis complying with those recommended in antibiotic guidelines
Positive on: when comparing the interventions groups, prescriptions consistent with recommendations in the guidelines increased
15. Eccles, 2007 {Eccles, 2007 #38}
RCT UK
Patients who need antidepressants for the treatment of depression
Prescription of cost-effective antidepressants
Pharmacist NO Process outcomes: prescribing of antidepressant drugs during intervention and 12 months after intervention.
No effect on: When comparing the study groups, there was no significant impact of the intervention on usage of antidepressants.
16.
Epstein, 2008 {Epstein, 2008 #39}
Before-after study US
Elementary school aged children with attention-deficit/hyperactivity disorder (ADHD)
Management of ADHD Physician YES Process outcomes: use of guidelines for the assessment and treatment of ADHD, use of parent and teacher assessment rating scales and systematic monitoring of responses to medication.
Positive on: After intervention, GPs showed substantial improvement in the use of guidelines for the assessment and treatment of ADHD. Use of parent and teacher assessment rating scales increased significantly. Systematic monitoring of responses to medication improved.
17. Etter, 2006 {Etter, 2006 #40}
RCT Switserland
Adults who smoke
Self-reporting of smoking cessation activities, recommending a computer-tailored smoking cessation programme and participation at a training workshop on tobacco dependency treatment
Nurse NO Process outcomes: percentage of patients the physicians counselled or treated for tobacco dependency and number of physicians who took part in a workshop.
Positive on: when comparing the intervention groups, the proportion of physicians who recommended to their patients the use of computer-tailored smoking cessation programme increased + the proportion of patients who received the advice to quit smoking increased
18. Feder, 1995 {Feder, 1995 #41}
RCT UK
Patients (adults) with asthma and/or diabetes
Prescribing in asthma, review of inhaler technique, review of asthma symptoms, glycaemic control, funduscopy, feet examination, weight, smoking habit, use of structured consultation ‘prompts’
Nurse (specialist nurse)
YES Biological outcomes: asthma—peak flow rate, prophylaxis, occupation and smoking habit/ diabetes: blood glucose concentration Process outcomes: prescribing in asthma, review of inhaler technique, review of asthma symptoms, glycaemic control, funduscopy, feet examination, weight,
Positive on: improvements in all seven diabetes variables (see above), improved recording of review of inhaler technique, smoking habit, and review of asthma symptoms, quality of prescribing in asthma. The use of structured prompts was associated with improved recording of four of seven
50 Academic Detailing – Supplement KCE reports 125
smoking habit, use of structured consultation ‘prompts’ Other: size of practice disease registers
variables on diabetes and all six variables on asthma. No effect on: sizes of disease registers were unchanged
19. Feldstein, 2006 {Feldstein, 2006 #42}
Time series US
Patients taking WARFARIN
Prescription of Warfarin Physician YES Process outcomes: the number of coprescriptions of warfarin-interacting medications per 10000 Warfarin users per month)
Positive on: reduction in the rate of Warfarin-interacting medication prescription No effect on: group academic detailing did not enhance alert effectiveness
20. Figueiras, 2001 {Figueiras, 2001 #44}
Controlled study Spain
Patients (adults) with osteoarthrosis with inflammation signs needing NSAIDs
Prescribing of NSAIDs Pharmacist NO Process outcomes: number of prescribed units of NSAIDs during intervention
Positive on: prescribing behaviour improvement in case of one-to-one education in the 9 months after intervention. In the education group improvement was also noted, but significant more improvement in one-to-one education group. Reminder increased significantly the effectiveness of the one-to-one intervention.
21. Figueiras, 2006 {Figueiras, 2006 #43}
RCT Portugal
Not specified (not applicable)
Reporting of ADRs Detailer, not specified
YES Process outcomes: reporting of ADRs
Positive on: increase in ADR reporting rates attributable to intervention for total ADRs, serious ADRs, high causality ADRs and unexpected ADRs for new drugs-related ADRs with the greatest difference to occur 4 months after intervention, and differences to remain statistically significant for 12 months.
22. Franzini, 2007 {Franzini, 2007 #45}
RCT US
Children needing immunization aged 12-23 months
Immunization Physician + team
YES Biological outcomes: immunization rates of children aged 12-23 months Process outcomes: self-reported provider behaviours (11 items)
Positive on: improvements of self-reported provider behaviour Negative on: costs—no favourable cost-benefit
KCE Reports 125 Academic Detailing – Supplement 51
aged 12-23 months Economic outcomes: cost of the intervention
ratio No effect on: Immunization rates
23. Freemantle, 2002 {Freemantle, 2002 #46}
RCT UK
Adults needing ACE inhibitors, raised cardiovascular risk patients needing aspirin, NSAIDs needing patients with joint pain, patients needing antidepressants.
Adherence to guidelines: prescription
Pharmacist NO Process outcomes: prescription of ACE inhibitors with loop diuretics to patients suffering from heart failure, aspirin, NSAIDs and antidepressants.
Positive on: AD was associated with a significant improvement in prescribing practice and an increase in the number of patients treated within the guideline recommendations.
24. Fretheim, 2006 {Fretheim, 2006 #47}
RCT Norway
Patients needing antihypertensive medication
Prescription of hypertensive drugs
Pharmacist YES Process outcomes: a) proportions of first-time prescriptions for hypertension where thiazides were prescribed + b) patients assessed for cardiovascular risk before prescribing antihypertensive or cholesterol-lowering drugs, c) patients treated for hypertension or hypercholesterolemia for 3 months or more who had achieved recommended treatment goals
Positive on: Significant shift in prescribing of hypertensive drugs towards the use of thiazides, No effect on: Little or no differences were found for risk assessment prior to prescribing and for achievement of treatment goal.
25. Fretheim, 2006
RCT Norway
Patients needing antihypertensive medication
Prescription of hypertensive drugs according to guidelines
Pharmacist YES Economic outcomes: cost-effectiveness of the intervention
Positive on: Significant shift in prescribing of hypertensive drugs towards the use of thiazides, and thus cost-lowering effects predicted over a two year period.
26. Frijling, 2003 {Frijling, 2003 #48}
RCT The Netherlands
Heart failure + hypertension, hypercholesterolemia and angina pectoris
Compliance rates for 12 evidence-based indicators for the management of patients with hypertension, hypercholesterolemia, angina pectoris or heart failure.
Non physicians, not specified
NO Process outcomes: assessment of risk factors in patients with hypercholesterolemia, angina pectoris, hypertension and heart failure.
Positive on: significant improvement when comparing the intervention arms was found for: the assessment of risk factors in patients with hypercholesterolemia and angina pectoris, provision of information and advice to patients with hypercholesterolemia and hypertension, checking for clinical signs of deterioration in patients with heart failure.
52 Academic Detailing – Supplement KCE reports 125
27. Gandjour, 2005 {Gandjour, 2005 #49}
Mathematical model Germany
Patients with heart failure: coronary heart failure (hypertension)
Prescription of antihypertensive drugs
Detailer, not specified
NO Economic outcomes:
Positive on: percentage of depressives prescribed first-generation tricyclics increased
28. Goldberg, 1998 {Goldberg, 1998 #50}
RCT US
Patients with hypertension and depression
Compliance with national guidelines for the primary care of hypertension and depression.
Physician YES Process outcomes: percentage of depressives prescribed first-generation tricyclics
No effect on: CQI-teams and AD in combination
29. Gomel, 1998 {Gomel, 1998 #51}
RCT Australia
Patients with hazardous alcohol consumption
Management of hazardous alcohol consumption (screening and counselling rates)
Pharmacist YES Process outcomes: screening and counselling rates. Economic outcomes: cost-effectiveness
Positive on: Update of the intervention package and recruitment rates better for AD compared to direct mail and tele-marketing. Tele-marketing was found to be more cost-effective than AD and direct mail in promoting the update of the package to improve screening and counselling for hazardous alcohol consumption.
30. Gonzales, 1999 {Gonzales, 1999 #52}
Controlled study US
Patients with uncomplicated acute bronchitis
Prescription of antibiotics
Detailer, not specified
YES Process outcomes: antibiotic prescription rates, return office visits within 30 days of the incident visit
Positive on: substantial decline in antibiotic prescription rates in intervention group, but not at the control and limited intervention group. No effect on: Return office visits within 30 days of the incident visit for bronchitis or pneumonia did not change significantly for any of the sites
31. Graham, 2008 {Graham, 2008 #53}
Before-after study Canada
Patients with osteoarthritis
Prescribing of cyclooxygenase-2 (COX-2) inhibitors, as well as examine the intervention effect on the utilization rates of gastroprotective agents and medical services.
Nurse and pharmacist
NO Biological outcomes: patient morbidity and mortality Process outcomes: change in COX-2 utilization rates from baseline, office visits rates visits/patients, use of protein pump inhibitor, mesoprostol and histamine2-receptor antagonist, GP office visits
Positive on: The osteoarthritis AD intervention was associated with a significant decrease in COX-2 utilization rates in the 3-month period immediately following the intervention. No effect on:
KCE Reports 125 Academic Detailing – Supplement 53
per patient, specialist office visits per patient and death rates per GP due to gastrointestinal complications
measures of patient morbidity and mortality due to gastrointestinal complications
32. Griffiths, 2004 {Griffiths, 2004 #54}
RCT UK
Respiratory diseases: asthma
Unscheduled care for asthma patients
Nurse YES Biological outcomes: rates of attendance for unscheduled care, self-management behaviour, asthma symptoms Psycho-social outcomes: quality of life Process outcomes: percentage of participants attending for unscheduled asthma care and the time to first attendance for unscheduled asthma care in the year after intervention.
Positive on: delayed time to first attendance when comparing intervention arms and reduction in the percentage of patients with acute asthma
33. Hall, 2001 {Hall, 2001 #55}
RCT UK
Patients with helicobacter pylori
Management of helicobacter pylori
Pharmacist YES Process outcomes: prescription of three drugs
Positive on: significant increase in omeprazole and metronidazole use No effect on: non-significant change in prescribing of dose units
34. Hennessy, 2006 {Hennessy, 2006 #56}
RCT US
Patients with hypertension
Ambulatory hypertension control.
Pharmacist YES Process outcomes: proportion of patients achieving blood pressure control below 140/90 mmHg + secondary analysis in patients with diabetes or kidney disease—controlled hypertension: 130/80 mmHg
No effect on: no effect or moderate effect among patients with hypertension.
35. Horn, 2007 {Horn, 2007 #57}
Time series Australia
Patients with hypertension
Changes in drug utilization following a national general practice education programme aimed at improving prescribing for hypertension.
Detailer, not specified
YES Process outcomes: use of thiazide or thiazide like diuretics at first line therapy for hypertension, use of low-dose formulations where thiazide diuretics were used, use of beta-blockers as first line therapy.
Positive on: increase in low-dose thiazide and beta-blocker prescribing.
54 Academic Detailing – Supplement KCE reports 125
36. Hulsher, 1997
Controlled study The Netherlands
Patients with cardiovascular disease
Prevention of cardiovascular disease
Nurse YES Process outcomes: prevention of cardiovascular disease
Positive on: Outreach visits were more effective than feedback in implementing guidelines to organise prevention. The increase in the number of practices adhering to the guidelines was significant for six out of 10 guidelinesNo effect on: the number of practices adhering to the guideline to make a follow up appointment did not reach significance
37. Ilett, 2000 {Ilett, 2000 #59}
RCT Australia
Patients with upper and lower respiratory tract infections, otitis media and urninary tract infections.
Antibiotic prescribing Pharmacist NO Process outcomes: total number of prescriptions for selected individual antibiotics
Positive on: when comparing the interventions arms, GPs in the intervention group prescribed amoxicillin and doxycilline (complied to guidelines) + positive effect on total costs of antibiotics
38. Jackson, 2004 {Jackson, 2004 #60}
Controlled study Australia
Patients with atrial fibrillation and an elevated risk to develop stroke
Reducing the risk of stroke through the use of antithrombotics (Warfarin) in patients with atrial fibrillation
Pharmacist NO Process outcomes: prescription of Warfarin and aspirin
Positive on: when comparing intervention arms: increased use of Warfarin in patient at high risk of stroke.
39. Kim, 1999 {Kim, 1999 #61}
RCT US
Patients needing immunization, mammography and clinical breast examination
Provision of preventive care services
Pharmacist YES Biological outcomes: rates of reported mammography Other: number of patients who reported to have received preventive care services (influenza, pneumococcal, tetanus immunization, exercise counselling)
Positive on: positive evolution in the number of influenza, pneumococcal, and tetanus immunization in both intervention and control. Mammography and clinical breast examination worsened in the education group only. Patient satisfaction scores improved in intervention group, but no significant result
40. Lemelin, 2001 {Lemelin, 2001 #62}
RCT Canada
Patients needing preventive actions
Improved prevention: folic acid supplementation, smoking cessation and
Nurse YES Process outcomes: folic acid supplementation, smoking cessation and hypertension treatment (index of preventive performance)
Positive on: when comparing intervention and control: index of preventive performance significantly better in
KCE Reports 125 Academic Detailing – Supplement 55
hypertension treatment intervention group +proportion of patients who received recommended preventive services No effect on: index of preventive performance
41.
Lin, 1997 {Lin, 1997 #63}
Before-after study US
Patients with depression
Management of depression
Detailer, not specified
YES Psycho-social outcomes: patient satisfaction and depression outcomes Process outcomes: physician selection of antidepressant medication, adequacy of pharmacotherapy, intensity and follow-up visits during the acute phase of depression treatment.
No effect on: no improvement in any of the outcomes measured.
42. Lin, 2001 {Lin, 2001 #64}
Before-after study US
Patients with depression
Management of depression
Detailer, not specified
YES Psycho-social outcomes: patient satisfaction and depression outcomes Process outcomes: new diagnoses per 100 primary care visits, new antidepressant medications per 100 visits, rate of new diagnosis accompanied by a new prescription per 100 visits, duration of pharmacotherapy
No effect on: no difference between intervention and control in the rate of new depression diagnosis, new prescription of antidepressant medicines,
43. Lobo, 2002 {Lobo, 2002 #65}
RCT The Netherlands
Patients needing cardiovascular preventive care
Cardiovascular preventive care.
Project team member
YES Other: deficiency score (the difference between ideal and actual practice)
Positive on: the duration of exposure was positively related to the change in availability of separate clinics and in the amount of teamwork. The improvement in instruments and materials was positively related to the GP’s opnion about the given feedback. No effect on: No relations were found between key characteristics and changes in record-keeping or follow-up
56 Academic Detailing – Supplement KCE reports 125
routines.
44. Lobo, 2002 {Lobo, 2002 #66}
RCT The Netherlands
Patients needing cardiovascular preventive care
Cardiovascular preventive care.
Project team member
YES Process outcomes: preventive tasks performed by the practice assistant (measurements taken, history questions asked, advice given on), follow-up including making an appointment immediately after the visit, making an identifiable note, providing an appointment car for patients. Other: availability of instruments and materials (e.g. blood pressure meter, glucose meter,...), leaflets, adequate ancillary staff present, separate room for practice assistant, teamwork in the practice, record keeping.
Positive on: when comparing the intervention arms, the difference in change was statistically significant for each aspect of organizing preventive care. The largest absolute improvement was found for the number of preventive tasks performed by the practice assistant.
45. Manfredi, 1998 {Manfredi, 1998 #67}
RCT US
Cancer (breast, cervical and colorectal cancers)
Screening of cancer (breast, cervical and colorectal cancers)
Detailer, not specified
YES Process outcomes: the proportions of patients with a chart-documented mammogram, clinical breast examination, Papanicolauo smear and occult blood slide test in 2 years before preintervention and postintervention chart abstractions.
Positive on: between baseline and postinterventions, there was a net increase in the proportion of HMO members in the intervention, compared to control practices for Papanicolauo smear and fecal occult blood slide test. There was a net increase in the proportion of non-HMO patients in the intervention compared with the control practices who received clinical breast examination and a fecal blood slide test.
46. Mason, 2001 {Mason, 2001 #68}
RCT UK
Heart failure and depression
Prescribing of medications of ACE inhibitors and SSRIs (selective serotonin reuptake inhibitor)
Pharmacist YES Economic outcomes: cost-effectiveness
Positive on: AD is cost-effective for implementation of ACE inhibitors + AD is cost-effective for a reduction in use of SSRIs in favour of triclyclic antidepressants in small practices
47. McDonald, 2003 {McDonald,
Before-after study Australia
Elderly patients with heart failure and chronic pain associated with
Prescribing for heart failure and chronic pain associated with
Pharmacist NO Psycho-social outcomes: satisfaction in physicians and pharmacists
Positive on: prescription of NSAID and triclyclic antidepressants
KCE Reports 125 Academic Detailing – Supplement 57
2003 #69}
osteoarthritisµ
osteoarthritis in an elderly population.
Process outcomes: Prescribing of NSAID, angiotensine converting enzyme inhibitor and triclyclic antidepressants
No effect on: prescription of angiotensine converting enzyme inhibitor
48. Midlov, 2006 {Midlov, 2006 #70}
RCT Sweden
Elderly patients needing: benzodiazepines and antipsychotic drugs
Prescribing of benzodiazepines and antipsychotic drugs
Pharmacist and physician
YES Process outcomes: prescribing of medium-and long-acting benzodiazepines and total benzodiazepines
Positive on: significant decreases in prescribing of medium-andlong-acting benzodiazepines and total benzodiazepines No effect on: decreases in prescribing of antipsychotic drugs
49. Mold, 2008{Mold, 2008 #71}
RCT US
Patients needing selected immunizations and preventive services
Preventive services. Principal investigator
YES Process outcomes: number of practices who implemented one or more of the evidence-based processes (selected immunizations and preventive services) + the number of total processes implemented
Positive on: Intervention practices implemented more of the processes than control practices overall, for adults and for children. Intervention practices were also more likely to implement at least one of the processes for children and to implement standing orders. Mammography rates increased significantly
50. Meyers, 2004
RCT US
Patients with an abnormal screening result for fecal occult blood > 50 years
Management of complete diagnostic evaluation (CDE) for persons with an abnormal screening result for fecal occult blood.
Nurse YES Process outcomes: CDE rates for FOBT
Positive on: CDE (complete diagnostic evaluation) recommendation and performance rates were both significantly higher in the intervention practices compared to the control practices
51. Naughton, 2007 {Naughton, 2007 #73}
RCT Ireland
Patients with CVD or diabetes
Prescribing of CVD preventive therapies (cardiovascular) in patients with CVD or diabetes at 3 and 6 months post intervention
Researcher YES Psycho-social outcomes: satisfaction in GPs Process outcomes: level of antiplatelet prescribing in patients with coronary heart disease, statin prescribing in patients with CVD and, antiplatelet and statin prescribing
Positive on: High level of satisfaction in GPs No effect on: there was a 3% increase in statin prescribing in CVD patients at 6 months post-intervention for both groups, but not statistically
58 Academic Detailing – Supplement KCE reports 125
in patients with diabetes
significant. Same for: statin and antiplatelet/warfarin prescribing in diabetic patients
52. New, 2004 {New, 2004 #74}
RCT UK
Patients with diabetes
Control of hypertension and hyperlipidemia in patients with diabetes.
Nurse YES Biological outcomes: percentage of patients that received adequate control= targets for blood pressure and lipid management Process outcomes: cholesterol control, blood pressure control,
No effect on: no improvement in the number of patients achieving target after 1 year; same for hyperlipidemia and hypertension.
53. Newton-Syms, 1992 {Newton-Syms, 1992 #75}
RCT UK
Patients who need NSAI medications
Prescribing to reduce costs
Pharmacist NO Economic outcomes: prescribing costs
Positive on: there was a decrease in the average prescribing cost per month in the intervention group compared with the reference group.
54. Nilsson, 2001 {Nilsson, 2001 #76}
RCT Sweden
Patients with hypertension, peptic ulcer/dyspepsia and depression
Prescribing rates of medications for hypertension, peptic ulcer/dyspepsia and depression.
Physician and pharmacist
YES Process outcomes: prescribing rates and DDDs per prescription in the year before and after the intervention
Positive on: significant effect on prescriptions for agents acting on the renin-angiotensin system. No effect on: prescribing rates of proton-pump inhibitors and medications for depression.
55. Ofman, 2003 {Ofman, 2003 #77}
RCT US
Patients with new dyspepsia and chronic users of antisecretory drugs.
Management of patients with acid-related disorders.
Pharmacist YES Biological outcomes: symptoms (epigastric pain, heartburn,..) Psycho-social outcomes: satisfaction with care, health-related quality of life
Positive on: improvements in helicobacter pylori testing, use of recommended helicobacter pylori treatment regimens, and discontinuation rates of proton pump therapy after treatment. No effect on: Few differences in patient quality of life and symptoms.
56. Ornstein, 2004{Ornstei
RCT US
Patients with (risk for) cardiovascular disease and
Prevention of cardiovascular disease
Physician, pharmacist
YES Biological outcomes: 7 outcome measures which reflected
Positive on: positive trends for the percentage
KCE Reports 125 Academic Detailing – Supplement 59
n, 2004 #78}
(risk for ) stroke
and stroke.
and person with experience in quality improvement
whether patients achieved recommended treatment goals. Process outcomes: 14 process measures reflecting if recommended tests were done, appropriate diagnoses made or appropriate medication prescribed. Percentage of performance targets achieved.
of quality indicators at or above target, Positive results for diagnoses of hypertension and blood pressure control in patients with hypertension, but no differences between intervention and control.
57. Paton, 2008 {Paton, 2008 #79}
RCT UK
Patients with schizophrenia
Prescribing of risperidone long-acting injection (RLAI)
Detailer, not specified
NO Process outcomes: prescribing of risperidone long-acting injection (RLAI) Other:
Prescribers ‘ knowledge of the evidence base and why RLAI is used
Positive on: AD was effective in changing prescribing practice (Rational Prescribing of risperidone long-acting injection (RLAI)
58. Peterson, 1996 {Peterson, 1996 #80}
Controlled study Australia
Patients with rheumatic disorders
Prescribing of NSAIDs
Pharmacist NO Process outcomes: (DDD) Daily Dosed Dispensed for NSAID compared to paracetamol Economic outcomes: hospital admissions due to gastric ulcers
Positive on: Changes in prescribing of NSAIDs were evident in both study regions, but were significantly greater in the intervention area compared to the control area. A decline in public hospital admissions was noted too.
59. Peterson, 1997 {Peterson, 1997 #81}
Controlled study Australia
Patients with urinary tract infections
Prescribing for antibiotics Pharmacist NO Process outcomes: the total DDDs dispensed for the recommended first-line agents (amoxicillin-potassium clavulanate, cephalexin and trimethoprim)
Positive on: total DDDs in intervention group
60. Pit, 2007 {Pit, 2007 #82}
RCT Australia
Elderly people taking benzodiazepines, NSAIDs/COX-2 inhibitors and antihypertensives.
Prescribing of NSAIDs and antihypertensives.
Pharmacist YES Biological outcomes: occurrence of falls Psycho-social outcomes: quality of life assessed by SF-12 and EQ-5D Scores Process outcomes: Use of benzodiazepines, NSAIDs and thiazide
Positive on: in intervention group; improved medication use composite score at 4-month follow-up (but not after 12 months), reduction in use of NSAIDs, benzodiazepines (not significant) and thiazide diuretics, lower number of falls and injury requiring medical attention.
60 Academic Detailing – Supplement KCE reports 125
diuretics Other: use of medication reviews
No effect on: Quality of life scores
61. Raisch, 1990 {Raisch, 1990 #83}
Controlled study US
Patients needing anti-ulcer agents
Prescribing of antiulcer agents
Pharmacist NO Process outcomes: prescribing of anti-ulcer agents (cimetidine, ranitidine and sucralfate)
Positive on: no differences in appropriateness were found between the two intervention groups, but in the first postintervention month the mean rate of inappropriate prescribing per control practitioner was 80% versus > 32% for the intervention groups. Positive effect on mean cost per control practitioner and per patient due to appropriate prescribing.
62. Ray, 1985 {Ray, 1985 #85}
Time series US
Patients needing antibiotics
Prescription of contra-indicated antibiotics and cephalosporins.
Physician and pharmacist
NO Process outcomes: average change index of contra-indicated antibiotics (chloramphenicol, clindamycin, tetracycline for children younger than 8 years) and cephalosporins.
Positive on: the beneficial effect of the physician-counselors persisted throughout year 2 with reductions in prescribing for both classes of drugs and cost savings. No effect on: reductions in prescribing in the group of pharmacist-counselors
63. Ray, 1986{Ray, 1986 #84}
RCT US
Patients needing benzodiazepine anxiolytic drug
Prescribing of Diazepam Physician NO Process outcomes: prescribing of diazepam Other: Receptivity of doctors to educational programme
Positive on: Lower prescribing of diazepam in intervention group and positive receptivity of doctors to educational programme
64. Ricordeau, 2003 {Ricordeau, 2003 #86}
Time series France
Patients with diabetes
Management of type 2 diabetes
Physician NO Process outcomes: monthly proportion of the number of HbA1c measurements to the total of laboratory tests
Positive on: the number of HbA1c tests (increase) and blood glucose measurements and urine microalbumin
65. Schuster, 2008 {Schuster, 2008 #87}
Controlled study US
Patients with obesity
Management of obesity
Detailer, not specified
YES Biological outcomes: cardiovascular disease risk factors: lipid levels, blood pressure and blood glucose
Positive on: the number of physicians that discussed obesity with their patients, reference to obesity
KCE Reports 125 Academic Detailing – Supplement 61
Process outcomes: documentation of physician obesity management: BMI, weight, record height to allow BMI calculation Other: Physician knowledge of obesity as a CVD factor
management increased, BMI and cardio-vascular co-morbidities improved.
66. Schaffner, 1983 {Schaffner, 1983 #109}
RCT US
Children needing antibiotics
Prescription of antibiotics
Physican and pharmacist
NO Process outcomes: Prescription of contraindicated antibiotics for use in office practice: chloramphenicol, clindamycin and tetracycline for children younger than 8 years and oral cephalosporins.
Positive on: when physician educators were used, strong attributable reductions in prescribing of both drug classes were obtained. The drug educator had only a modest effect. No effect on: The mailed brochure had no detectable effect.
67. Shanahan, 2006 {Shanahan, 2006 #88}
Modelling approach Australia
People abusing alcohol
Screening of alcohol abuse
Detailer, not specified
NO Process outcomes: screening for alcohol abuse in adults
Positive on: achieving a decrease in the number of standards drinks consumed by risky drinkers.
68. Siegel, 2003 {Siegel, 2003 #89}
Before-after study US
Patients with hypertension, diabetes mellitus and heart failure
Management of hypertension
Detailer, not specified
YES Process outcomes: prescription of thiazide diuretics, beta-blockers and calcium antagonists, angiotensine converting enzyme inhibitor, angiotensine receptor blocker
Positive on: prescribing of number of calcium antagonists, beta-blockers, thiazide diuretics for patients with hypertension. For hypertensive subjects with diabetes mellitus or congestive heart failure, the proportion receiving an angiotensine converting enzyme inhibitor or angiotensin receptor blocker increased. Among hypertensive subjects with coronary artery disease and increase in beta-blocker use was noted.
69. Simon, 2005 {Simon, 2005 #90}
RCT US
Patients with newly diagnosed hypertension
Prescription of diuretic or beta-blocker use in hypertension
Detailer, not specified
NO Process outcomes: rates of diuretic or beta-blocker use increased in both individual and group
Positive on: rates of diuretic or beta-blocker use increased in both individual and group AD practices
62 Academic Detailing – Supplement KCE reports 125
AD practices No effect on: neither intervention affected blood pressure control
70. Simon, 2007 {Simon, 2007 #91}
Retrospective study US
Patients with hypertension
Prescription of diuretic or beta-blocker use in hypertension
Detailer, not specified
NO Economic outcomes: average daily drug cost
Positive on: the individual AD resulted in an estimated net decrease in average daily drug cost per person beyond the reductions in the mail group, although this finding did not reach statistical significance. The estimated net reduction corresponded to savings.
71. Siriwardena, 2002 {Siriwardena, 2002 #93}
RCT UK
High risk patients (age > 65 years, coronary heart disease, diabetes and a history of splenectomy) needing influenza and pneumoccocal vaccinations.
Influenza and pneumoccocal vaccinations
Physician YES Process outcomes: rates of influenza and pneumoccocal vaccination for patients age > 65 years, coronary heart disease, diabetes and a history of splenectomy
Positive on: Improvements in pneumoccocal vaccination rates in the intervention practices were significantly greater compared to controls in patients with CHD and diabetes but not splenectomy. Improvements for influenza vaccination were also greater in intervention practices but did not reach statistical significance.
72. Sheinfeld, 2000 {Sheinfeld Gorin, 2000 #92}
Before-after US
Patients with cancer (colon, rectum, cervix, prostate, breast and lung)
Cancer prevention and screening practices
Bachelors, masters and public health professionals
YES Process outcomes: self-reported cancer prevention and screening practices Other: knowledge of ACS screening guidelines for the colon, rectum, cervix, prostate, breast and lung
Positive on: Identified barriers to practice No effect on: no significant differences in knowledge of cancer prevention or screening.
73. Stone, 2005 {Stone, 2005 #94}
Modelling approach Australia
Patients with cancer (prostate cancer)
PSA screening Pharmacist NO Economic outcomes:
Positive on: A national programme would reduce the burden of disease by 4.7% of total DALYs due to prostate cancer in those aged 70 and over, with no loss of life and an incremental cost effectiveness ratio of 16.000/DALY (gross) and 8.500/DALY (net).
74. Teng, 2006 Time series Malaysia Patients with respiratory Prescription of antibiotics Physician YES Process outcomes: Positive on:
KCE Reports 125 Academic Detailing – Supplement 63
{Teng, 2006 #95}
diseases (Upper respiratory Tract Infections)
prescription of antibiotics
reductions in the prescription of antibiotics for URTI
75. Turner, 2000 {Turner, 2000 #96}
RCT US
Patients with congestive heart failure
Prescription of ACE inhibitors and angiotensin 2 receptor antagonists for the prevention and management of CHF.
Pharmacist NO Process outcomes: self-reported use of prescription of ACE inhibitors and angiotensin 2 receptor antagonists for the prevention and management of CHF.
No effect on: no significant difference in ACE-inhibitor prescribing between intervention and control group
76. Varonen, 2007 {Varonen, 2007 #100}
RCT Finland
Patients with respiratory diseases: acute maxillary sinusitis
Prescribing of antibiotics for maxillary sinusitis
Physician NO Process outcomes: prescribing of antibiotics for acute maxillary sinusitis (Amoxicillin), proportion of courses of antibiotics with recommended duration
Positive on: Use of first line drugs (amoxicillin): increased No effect on: there were no significant changes between AD and problem-based learning methods.
77. Van den Hombergh, 1999 {van den Hombergh, 1999 #97}
RCT The Netherlands
Not applicable
Global Practice functioning
Physician NO Psycho-social outcomes: job-stress in physicians Process outcomes: delegation and collaboration Other: Premises and equipment, service and organization, record keeping, organisation of quality improvement, workload
Positive on: both programmes resulted into improvements on many aspects of practice management. Practice visits by peers resulted into better performance for equipment, collaboration with colleagues, accessibility of patient information than after a visit of a non physician observer. Visits by non physician observers resulted in a higher score on extent of use of records, outcome assessment and year report.
78. Van der Wijden, 1999 {van der Weijden, 1999 #98}
RCT The Netherlands
Patients with abnormal cholesterol levels
Management of cholesterol
Scientific collaborator
YES Process outcomes: quality of selective case finding (= targeting cholesterol testing to patients with at least one of the six risk factors mentioned in the guideline), and quality of diagnostic procedures (= properly diagnosed hypercholesterolemia requires that average of 3 measurements to be higher than 6.5 mmol/l)
Positive on: quantity of cholesterol testing Negative on: performance of the procedure necessary to diagnose hypercholesterolemia even deteriorated No effect on: quality of selective case finding or quality of diagnostic procedures
64 Academic Detailing – Supplement KCE reports 125
79. Van Eijk, 2001 {van Eijk, 2001 #99}
RCT The Netherlands
Elderly patients (> 60) needing anticholinergic antidepressants
Prescribing of highly anticholinergic antidepressants in elderly people.
Researcher YES Process outcomes: numbers of elderly people with new prescriptions of highly anticholinergic antidepressants and less anticholinergic antidepressants
Positive on: in both the intervention arms the use of highly anticholinergic antidepressants decreased + the use of less anticholinergic antidepressants increased.
80. Walsh, 2005 {Walsh, 2005 #101}
RCT US
Patients at risk for development of colorectal cancer
Colorectal cancer screening (patients aged 50-79)
Physician YES Process outcomes: FOBT in the last 2 years, flexible sigmoidoscopy and colonoscopy in the previous 5 years, CRC screening
Positive on: patient rates of screening SIG (flexible sigmoidoscopy) No effect on: rates of CRC screening.
81. Watson, 2001 {Watson, 2001 #102}
RCT UK
Patients needing non-steroidal anti-inflammatory drugs (NSAIDs).
Prescribing for non-steroidal anti-inflammatory drugs (NSAIDs).
Pharmacist YES
Process outcomes: change in the volume prescription (DDD) of ibuprofen, diclofenac and naproxen (= recommended NSAIDs) as a percentage of total NSAID prescribing Economic outcomes: cost-benefit analysis
Positive on: the proportion of prescribing of the five most frequently used drugs. Negative on: a net increase in costs with both interventions No effect on: prescription of ibuprofen, diclofenac and naproxen
82. Weller, 2003 {Weller, 2003 #103}
RCT Australia
Patients with prostate cancer
Prostate-specific antigen testing (PSA)
Pharmacist YES Process outcomes: PSA testing rates Other: GP knowledge
Positive on: correct responses to questions about prostate cancer treatment effectiveness and endorsement of PSA testing for prostate cancer by professional bodies. No effect on: PSA testing rate lower in AD group compared to mail group and control group.
83. Williams, 1994 {Williams, 1994 #104}
Before-after US
Patients with breast, colon-rectum and prostate cancer
Screening and preventive actions on breast, colon-rectum and prostate cancer.
Physician and nurse
YES Process outcomes: activities in compliance with cancer prevention guidelines
Positive on: compliance rates + increased awareness of resources of ACS and in prompting physicians to adopt cancer prevention and screening procedures, but least
KCE Reports 125 Academic Detailing – Supplement 65
effective in making office changes.
84. Witt, 2004 {Witt, 2004 #105}
RCT Denmark
Patients with respiratory diseases: asthma (children < 16 years of age)
Prescription of asthma medication (to change medication in children to more inhaled steroids and less B2-aginists, and to increase the GPs use of peak-flow meters and spirometry).
Researchers YES Process outcomes: number of asthma medication prescribed (DDD of steroids and B2-agonists expressed as sales of asthma medication by pharmacies).
No effect on: prescription of asthma medication
85. Wong, 2004 {Wong, 2004 #106}
RCT Canada
Elderly patients
Management of geriatric patients: geriatric knowledge on cognitive impairment, competency, urinary incontinence, malnutrition, and stroke.
Specialist in geriatric medicine
YES Other: Knowledge score on geriatric knowledge
Positive on: improvements in geriatric knowledge scores
86. Young, 2002 {Young, 2002 #107}
RCT Australia
Patients who smoke (age 18-70 years)
Smoking cassation advice Detailer, not specified
YES Process outcomes: recall of GPs advice about nicotine replacement patches and gum, patient recall of assessment of smoking status and GP use of ‘quit dates’, behavioural advice and provision of written materials
Positive on: recall of GPs advice about nicotine replacement patches and gum. No effect on: Positive increases but not significant for: patient recall of assessment of smoking status and GP use of ‘quit dates’, behavioural advice and provision of written materials
87. Zwar, 2000 {Zwar, 2000 #108}
RCT Australia
Patients (long term users of ) benzodiazepines
Prescription of benzodiazepines
Physician YES Process outcomes: rate of benzodiazepine prescribing for all indications, for anxiety and sleep disorders
Positive on: Overall benzodiazepine prescribing (in continuing rather than initial prescriptions), but no difference between groups
–
66 Academic Detailing – Supplement KCE reports 125
1.5 DESCRIPTION OF THE 87 STUDIES SELECTED Study number 1. Study included
Aspy, 2008
Aspy CB, Enright M, Halstead L, Mold JW. Improving mammography screening using best practices and practice enhancement assistants: An Oklahoma Physicians Resource/Research Network (OKPRN) study. Journal of the American Board of Family Medicine. 2008;21(4):326-33.
Quality appraisal score " 13/14
Country ## Europe
" US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives " To apply a multi-component implementation intervention to the problem of
breast cancer screening within community practices that are members of a research based network, with the goal to improve mammography rates.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Healthy woman age > 50y
Caregiver targeted " Family physician (= general practitioner)
## Specialist
## Type of physician not specified
Behavior targeted " Prescribing of mammography
Who does academic detailing ## Nurse
## Physician
KCE Reports 125 Academic Detailing – Supplement 67
## Pharmacist
## Other
" Not specified
Interventions " INTERVENTION: 1) audit results and a comparison with a with a network
benchmark, 2) academic detailing of exemplar principles and information from the
medical literature, 3) services from a practice facilitator for 9 months, 4)
information technology support if requested.
" CONTROL: no feedback or practice change facilitation
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: rates of mammography prescription
## Economic outcomes
## Other:
" Positive on: rates of mammography prescription
## Negative on:
## No effect on:
Conclusion: AD is effective on mammography prescription.
68 Academic Detailing – Supplement KCE reports 125
Study number 2. Study included
Avorn, 1983
Avorn J, Soumerai SB. Improving drug-therapy decisions through educational outreach. A randomized controlled trial of academically based "detailing". N Engl J Med. 1983;308(24):1457-63.
Quality appraisal score " 9/14
Country ## Europe
" US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To evaluate the effectiveness of academic detailing in the reduction of the excessive use of three drug groups: cerebral and peripheral vasodilators, an oral cephalosporin and propoxyphene.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients needing cerebral and peripheral vasodilators, an oral cephalosporin and propoxyphene.
Caregiver targeted " Family physician (= general practitioner)
## Specialist
## Type of physician not specified
Behavior targeted " Reducing the excessive use of three drug groups: cerebral and peripheral
vasodilators, an oral cephalosporin and propoxyphene.
KCE Reports 125 Academic Detailing – Supplement 69
Who does academic detailing ## Nurse
## Physician
" Pharmacist
## Other
Interventions " INTERVENTION: face-to-face AD + educational materials
" INTERVENTION: printed-materials only
" CONTROL: no intervention
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: use of three drug groups: cerebral and peripheral vasodilators, an oral cephalosporin and propoxyphene.
" Economic outcomes: costs
## Other:
" Positive on: Significant reductions in the number of target drugs in intervention
group compared to control group + cost reductions
## Negative on:
## No effect on:
Conclusion: AD is useful and cost-effective to improve the quality of drug-therapy decisions
and reduce costs.
70 Academic Detailing – Supplement KCE reports 125
Study number 3. Study included
Benincasa, 1996
Benincasa TA, King ES, Rimer BK, Bloom HS, Balshem A, James J, et al. Results of an office-based training program in clinical breast examination for primary care physicians. Journal of Cancer Education. 1996;11(1):25-31.
Quality appraisal score " 8/14
Country ## Europe
" US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design ## RCT
## Controlled study (prospective/retrospective):
" Before-after: one group pretest/posttest design
## Time series:
Objectives
To implement an office-based training program in clinical breast examination (CBE) to improve lump-detection skills of primary care physicians.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted " Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
Caregiver targeted " Family physician (= general practitioner)
## Specialist
## Type of physician not specified
Behavior targeted " CBE and lump-detection skills in physicians.
Who does academic detailing ## Nurse
## Physician
KCE Reports 125 Academic Detailing – Supplement 71
## Pharmacist
" Other: non physician experts in CBE
Interventions ## INTERVENTION:
## CONTROL:
" CBE skill training, and didactic discussion + educational package on breast
cancer screening that included recent journal articles, breast cancer screening
guidelines, and a complementary silicone breast model + credits for continuing
medical education
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: number of lump detections
## Economic outcomes
## Other:
" Positive on: the mean number of correct lump detections increased
significantly, and the number of false positives decreased
## Negative on:
## No effect on:
Conclusion: The academic detailing model improved the physicians abilities to correctly detect
lumps in a silicone breast model
72 Academic Detailing – Supplement KCE reports 125
Study number 4. Study included
Berings, 1994
Berings D, Blondeel L, Habraken H. The effect of industry-independent drug information on the prescribing of benzodiazepines in general practice. Eur J Clin Pharmacol. 1994;46(6):501-5.
Quality appraisal score " 9/14
Country " Europe: Belgium!
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To measure the effect of industry-independent information on the prescribing of benzodiazepines in general practice
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Other: general population
Caregiver targeted " Family physician (= general practitioner)
## Specialist
## Type of physician not specified
Behavior targeted " Prescription behaviour of benzodiazepines
Who does academic detailing ## Nurse
KCE Reports 125 Academic Detailing – Supplement 73
" Physician: GENERAL PRACTITIONER
## Pharmacist
## Other
Interventions " INTERVENTION I: oral and written information about the indications and
limitations of benzodiazepines
" INTERVENTION II: written information
" CONTROL: No information at all
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
" Psycho-social outcomes: attitude of physicians about the value of oral drug
information from an industry-independent source
" Process outcomes: number of benzodiazepines prescribed per 100 patient
contacts
## Economic outcomes
## Other:
" Positive on: average decrease of 3% in control group and of 14% in physicians
who received written information, and 24% in physicians who were given oral
information + positive attitude towards the value of oral drug information from an
industry-independent source
## Negative on:
## No effect on:
74 Academic Detailing – Supplement KCE reports 125
Study number 5. Study included
Bonds, 2009
Bonds DE, Hogan PE, Bertoni AG, Chen H, Clinch CR, Hiott AE, et al. A multifaceted intervention to improve blood pressure control: The Guideline Adherence for Heart Health (GLAD) study. American Heart Journal. 2009;157(2):278-84.
Quality appraisal score " 13/14
Country ## Europe
" US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective)
## Before-after:
## Time series:
Objectives
" To improve blood pressure control through a multifactorial intervention
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with hypertension
Caregiver targeted " Family physician (= general practitioner)
## Specialist
## Type of physician not specified
Behavior targeted " Blood pressure control
Who does academic detailing ## Nurse
## Physician
## Pharmacist
KCE Reports 125 Academic Detailing – Supplement 75
## Other
" Not specified
Interventions " INTERVENTION: initial educational session, paper copy of guidelines, four 1
hour academic detailing sessions every 6 months, educational material for patients
+ provider material (e.g. automatic blood pressure machines), feedback on the
preintervention hypertension diagnosis and control levels for the practice
" CONTROL: intervention to improve compliance to cholesterol, 4 academic
detailing sessions every 6 months, feedback, educational material for both patients
and providers about cholesterol management
Multifaceted intervention? " YES
Outcomes " Biological outcomes: medical co-morbidities, blood pressure values, recommendations
of therapeutic life style changes, number of blood pressure medications. Key: mean SBP and
DBP,
## Psycho-social outcomes
" Process outcomes: percent of patients at or below JNC 7 blood pressure goal; percent
of patients with undiagnosed hypertension, intensification of therapy in those not at goal, and
appropriate selection of initial therapy in those with newly diagnosed hypertension
## Economic outcomes
## Other:
## Positive on:
## Negative on:
" No effect on: no difference between 2 groups in any of the adherence
measures.
Conclusion:
76 Academic Detailing – Supplement KCE reports 125
Study number 6. Study included
Braybrook, 1996
Braybrook S, Walker R. Influencing prescribing in primary care: a comparison of two different prescribing feedback methods. J Clin Pharm Ther. 1996;21(4):247-54.
Quality appraisal score " 9/14
Country ## Europe
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
To evaluate two different methods of providing practice-based, antibiotic prescribing feedback to general practitioners.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients who need antibiotics
Caregiver targeted " Family physician (= general practitioner): 66 practices
## Specialist
## Type of physician not specified
Behavior targeted " Antibiotic prescribing
Who does academic detailing ## Nurse
## Physician
KCE Reports 125 Academic Detailing – Supplement 77
" Pharmacist
## Other
Interventions " INTERVENTION: face-to-face prescribing discussion visits
" INTERVENTION II: provision of practice specific prescribing analysis
workbooks
" CONTROL: NO INTERVENTION
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: antibiotic prescribing indicators (= medications)
" Economic outcomes: costs
## Other:
" Positive on: changes in antibiotic prescribing indicators were greater in
intervention compared to control group + reduced costs
## Negative on:
## No effect on:
Conclusion: face-to-face visits proved most successful to influence GP prescribing, although
the workbook promoted more change than seen in the control group.
78 Academic Detailing – Supplement KCE reports 125
Study number 7. Study included
Broadhurst, 2007
Broadhurst NA, Barton CA, Rowett D, Yelland L, Matin DK, Gialamas A, et al. A before and after study of the impact of academic detailing on the use of diagnostic imaging for shoulder complaints in general practice. BMC Family Practice. 2007;8(12).
Quality appraisal score " 9/14
Country ## Europe
## US
## Canada
" Australia
## Asia (specify)
Initiator " Not specified Design ## RCT
## Controlled study (prospective/retrospective):
" Before-after
## Time series:
Objectives " To assess the impact of AD on GP’s use of diagnostic imaging for shoulder
complaints in general practice and their knowledge and confidence to manage shoulder pain.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" People with shoulder pain
Caregiver targeted " Family physician (= general practitioner)
## Specialist
## Type of physician not specified
Behavior targeted " Use of diagnostic imaging for shoulder complaints in general practice and their
knowledge and confidence to manage shoulder pain.
Who does academic detailing ## Nurse
## Physician
KCE Reports 125 Academic Detailing – Supplement 79
## Pharmacist
" Other: specialist
Interventions " INTERVENTION: AD + clinical guidelines + video/DVD on how to examine the
shoulder, 1 session, lasting 30 to 60 minutes
## CONTROL: NA
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: requests for ultrasound imaging, knowledge about
identifying and managing shoulder problems
" Economic outcomes
## Other:
" Positive on: requests for ultrasound imaging decreased significantly after six
months of AD + knowledge and confidence
## Negative on:
" No effect on: no effect on the rate of requests over time in the control groups
Conclusion: AD together with education materials and guidelines can improve GPs’ knowledge
and confidence to manage shoulder problems and reduce the use of imaging, at least in the
short term.
80 Academic Detailing – Supplement KCE reports 125
Study number 8. Study included
Brown, 2000
Brown JB, Shye D, McFarland BH, Nichols GA, Mullooly JP, Johnson RE. Controlled trials of CQI and academic detailing to implement a clinical practice guideline for depression. Jt Comm J Qual Improv. 2000;26(1):39-54.
Quality appraisal score " 12/14
Country ## Europe
" US: US (Portland, Oregon)
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives " To evaluate the effectiveness of two clinical practice guidelines implementation methods
(continuous quality improvement and Academic detailing) in an HMO organisation.
Setting " Physician’s office
## Primary care clinic
" Other (specify): HMO
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with depression: 928
Caregiver targeted " Family physician (= general practitioner)
## Specialist
## Type of physician not specified
Behavior targeted ## Guideline adherence for the management of depression
Who does academic detailing ## Nurse
KCE Reports 125 Academic Detailing – Supplement 81
## Physician
" Pharmacist
Interventions " INTERVENTION: AD (4 visits) containing three primary messages on the
management of depression + educational materials + guideline + Continuous
Quality Improvement Team (CQI)= multidisciplinary team implementing guideline
on depression
" CONTROL: usual care
Multifaceted intervention? " YES
Outcomes " Biological outcomes: HSCL-D, receipt of depression treatment, score of SF-36
## Psycho-social outcomes
" Process outcomes: clinician knowledge, attitude and practices related to the
detection and treatment of depression
" Economic outcomes: dispensing of antidepressant medication
## Other:
" Positive on: number of antidepressants
" Negative on: deterioration in self-reported physical functioning and vitality,
more depressive cohort patients of control physicians improved compared to
patients of AD-exposed patients
" No effect on: no changes in mean depression symptoms
Conclusion: New organizational structures may be necessary before CQI and AD detailing can
change complex processes such as the primary care of depression.
82 Academic Detailing – Supplement KCE reports 125
Study number 9. Study included
Browner, 1994
Browner WS, Baron RB, Solkowitz S, Adler LJ, Gullion DS. Physician management of hypercholesterolemia. A randomized trial of continuing medical education. West J Med. 1994;161(6):572-8.
Quality appraisal score " 11/14
Country ## Europe
" US: San Francisco
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives " To determine the effect of continuing medical education (CME) on compliance
with the recommendations of the National Cholesterol Education Program expert Panel on high serum cholesterol levels in adults.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with high serum cholesterol levels
Caregiver targeted " Family physician (= general practitioner): 174 practices in three groups
## Specialist
## Type of physician not specified
Behavior targeted " Compliance with recommendations of the National Cholesterol Education
Program expert Panel on high serum cholesterol levels in adults.
Who does academic detailing ## Nurse
KCE Reports 125 Academic Detailing – Supplement 83
## Physician
## Pharmacist
## Other
" Not specified
Interventions " INTERVENTION I: three-hour seminar on high serum cholesterol levels +
follow-up seminars and free official materials + AD (not specified how many or
intensity) + follow-up seminars
" INTERVENTION II: three-hour seminar on high serum cholesterol levels
" CONTROL: seminar on hypercholesterolemia + educational materials
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: proportion of patients whose management complied to the
NCEP guidelines = Screening for total cholesterol, determination of LDL-
cholesterol, treatment of elevated LDL-cholesterol level, screening for
hypercholesterolemia, treatment, follow-up for high serum cholesterol levels,
measurements of HDL-cholesterol and triglyceride
## Economic outcomes
## Other:
## Positive on:
## Negative on:
" No effect on: no significant differences in screening for high serum cholesterol
or compliance with guidelines between the groups receiving CME and the control
group. There was a trend toward a modest benefit from the CME interventions.
Conclusion: No significant effects measured.
84 Academic Detailing – Supplement KCE reports 125
Study number 10. Study included
COENEN, 2004
Coenen S, Van Royen P, Michiels B, Denekens J. Optimizing antibiotic prescribing for acute cough in general practice: a cluster-randomized controlled trial. J Antimicrob Chemother. 2004;54(3):661-72.
Quality appraisal score " 11/14
Country " Europe: Belgium
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design ## RCT
## Controlled study (prospective/retrospective):
" Before-after: (clustered –randomized before-after)
## Time series:
Objectives " To assess the effect of a tailored professional intervention including AD on
antibiotic prescribing for acute cough
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients (adults) who need antibiotics for acute cough
Caregiver targeted " Family physician (= general practitioner): 85
## Specialist
## Type of physician not specified
Behavior targeted " Antibiotics prescribing for acute cough
Who does academic detailing ## Nurse
## Physician
" Pharmacist
KCE Reports 125 Academic Detailing – Supplement 85
## Other
Interventions " INTERVENTION: booklets and leaflets of a public campaign + a clinical
practice guideline for the management of acute cough (no specification on duration
of AD!), an educational outreach visit + materials+ and a postal reminder of the key
messages
" CONTROL: no intervention
Multifaceted intervention? " YES
Outcomes " Biological outcomes: patients’ symptom resolution due to change in antibiotic
prescribing
## Psycho-social outcomes
" Process outcomes: antibiotics prescribing rates + type of antibiotics prescribed
" Economic outcomes: medication cost per patient from a public perspective
## Other:
" Positive on: Less prescribing in intervention group + prescribed antibiotics
more in line with guideline in intervention group and less expensive from public
perspective
## Negative on:
" No effect on: patients’ symptom resolution
Conclusion: A tailored intervention implementing a guideline for acute cough is successful in
optimizing antibiotic prescribing without affecting patients’ symptom resolution.
86 Academic Detailing – Supplement KCE reports 125
Study number 11. Study included
CRANNEY, 1999
Cranney M, Barton S, Walley T. Addressing barriers to change: an RCT of practice-based education to improve the management of hypertension in the elderly. Br J Gen Pract. 1999;49(444):522-6.
Quality appraisal score " 9/14
Country " Europe: UK
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives " To establish whether an exploration of barriers to change can enhance the
effectiveness of an educational intervention designed to improve the management of hypertension in the elderly
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Elderly with hypertension
Caregiver targeted " Family physician (= general practitioner): 76
## Specialist
## Type of physician not specified
Behavior targeted " Treating systolic hypertension in the elderly (patient aged 70 to 79 years)
Who does academic detailing ## Nurse
## Physician
KCE Reports 125 Academic Detailing – Supplement 87
## Pharmacist
" Other: researcher
Interventions " INTERVENTION: semi-structured vist (one hour) in small groups with
feedback and audit results, exploration of participants views on the significance of
the results, discussion of the evidence-base for the treatment of hypertension in the
elderly, exploration of current practice concerning hypertension management,
identification of potential barriers to change, creation of a practice action plan to
address the above issues, discussion on how an audit might be performed
" CONTROL: all above but without identification of potential barriers to change,
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: management of systolic hypertension and a specific patient
scenario
## Economic outcomes
## Other:
" Positive on: significant difference in the stated threshold for treating systolic
hypertension between intervention and control + difference in the willingness to
treat patient (case) with mild hypertension
## Negative on:
## No effect on:
Conclusion: The effectiveness of an educational intervention is significantly improved by
addressing the barriers preventing GPs from implementing findings of research.
88 Academic Detailing – Supplement KCE reports 125
Study number 12. Study included
DE BURG, 1995
de Burgh S, Mant A, Mattick RP, Donnelly N, Hall W, Bridges-Webb C. A controlled trial of educational visiting to improve benzodiazepine prescribing in general practice. Aust J Public Health. 1995;19(2):142-8.
Quality appraisal score " 11/14
Country ## Europe
## US
## Canada
" Australia
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives " To evaluate the effect of educational practice visiting on benzodiazepine
prescribing in patients with anxiety
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with anxiety
Caregiver targeted " Family physician (= general practitioner): 286
## Specialist
## Type of physician not specified
Behavior targeted " Benzodiazepine prescribing in patients with anxiety
##
Who does academic detailing ## Nurse
KCE Reports 125 Academic Detailing – Supplement 89
" Physician
" Pharmacist
## Other
Interventions " INTERVENTION: educational visit (20 minutes, receptive educational
approach) + educational materials= guidelines + a patient review card + access to
relaxation audio tapes and video series on sleep + a follow-up call
" CONTROL:
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: benzodiazepine prescribing rate, axiety and insomnia
diagnosis rates
## Economic outcomes
## Other:
" Positive on: when comparing the intervention arms, benzodiazepine
prescribing rate, axiety and insomnia diagnosis rates declined significantly, also
initial prescription rates, differential downward trend in c per insomnia diagnosis,
but not to a statistical level.
## Negative on:
" No effect on: prescribing for anxiety diagnosis.
Conclusion: Although positive effects were noted, AD is not justified in an unselected
population of GP’s.
90 Academic Detailing – Supplement KCE reports 125
Study number 13. Study included
DEY, 2004
Dey P, Simpson CW, Collins SI, Hodgson G, Dowrick CF, Simison AJ, et al. Implementation of RCGP guidelines for acute low back pain: a cluster randomised controlled trial. Br J Gen Pract. 2004;54(498):33-7.
Quality appraisal score " 12/14
Country " Europe: UK
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To investigate the impact on patient management of an educational strategy to promote guidelines for the management of low back pain in primary care
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients (adults) with low back pain
Caregiver targeted " Family physician (= general practitioner): 54 general practices
## Specialist
## Type of physician not specified
Behavior targeted " Medical management of low back pain in adults= rate of referral for lumbar
spine X-rays, issuing of sickness certification, referral to secondary care and
prescription of muscle relaxants and opioid analgesics.
KCE Reports 125 Academic Detailing – Supplement 91
Who does academic detailing ## Nurse
## Physician
## Pharmacist
" Other: senior representatives, health authority
Interventions " INTERVENTION: outreach visits to promote national guidelines + access to
fast-track physiotherapy and to a triage service for patients with persistent
symptoms. Ad included raising awareness on guidelines, emphasise key messages in
guidelines, identify potential barriers to implementation and suggesting strategies
to overcome barriers identified + posters
## CONTROL: no visit from guidelines team and no direct access to the back clinic
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: rate of referral for lumbar spine X-rays, issuing of sickness
certification, referral to secondary care and prescription of muscle relaxants and
opioid analgesics.
## Economic outcomes
## Other:
" Positive on: significant differences between study groups for referral to
physiotherapists or the back pain unit
## Negative on:
" No effect on: no significant differences between study groups in proportion of
patients who were referred for X-ray, issued with a sickness certificate, prescribed
opioids or muscle relaxants, or were referred to secondary care.
Conclusion: Management of low back pain mostly unchanged by AD, but an increase in referral
to physiotherapy and back pain unit.
92 Academic Detailing – Supplement KCE reports 125
Study number 14. Study included
DE SANTIS, 1994
De Santis G, Harvey KJ, Howard D, Mashford ML, Moulds RF. Improving the quality of antibiotic prescription patterns in general practice. The role of educational intervention. Med J Aust. 1994;160(8):502-5.
Quality appraisal score " 9/14
Country ## Europe
## US
## Canada
" Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To assess the quality of antibiotic prescribing by GPs and the effectiveness of educational intervention techniques in improving prescribing of antibiotics for tonsillitis.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients (adults) who need antibiotics for tonsillitis
Caregiver targeted " Family physician (= general practitioner): 182 (104 intervention, 78 control)
## Specialist
## Type of physician not specified
Behavior targeted " Improving prescribing of antibiotics for tonsillitis.
KCE Reports 125 Academic Detailing – Supplement 93
Who does academic detailing ## Nurse
## Physician
" Pharmacist
## Other
Interventions " INTERVENTION: 3-month educational mailing campaign (brochure) + five
mailings) + AD by pharmacist (intensity not specified!)
## CONTROL: no intervention
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: the percentage of prescriptions of antibiotics for tonsillitis
complying with those recommended in antibiotic guidelines
## Economic outcomes
## Other:
" Positive on: when comparing the interventions groups, prescriptions consistent
with recommendations in the guidelines increased
## Negative on:
## No effect on:
Conclusion: The educational campaign significantly improved the prescribing of appropriate
antibiotics for tonsillitis by GPs
94 Academic Detailing – Supplement KCE reports 125
Study number 15. Study included
ECCLES, 2007
Eccles MP, Steen IN, Whitty PM, Hall L. Is untargeted educational outreach visiting delivered by pharmaceutical advisers effective in primary care? A pragmatic randomized controlled trial. Implement Sci. 2007;2:23.
Quality appraisal score " 11/14
Country " Europe: UK
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT (pragmatic cluster randomized controlled trial)
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To evaluate the effectiveness of routine outreach on the prescription of cost-effective antidepressants in primary care.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients who need antidepressants for the treatment of depression
Caregiver targeted " Family physician (= general practitioner): 73 practices—36 intervention, 37
control.
## Specialist
## Type of physician not specified
Behavior targeted " Prescription of cost-effective antidepressants in primary care.
KCE Reports 125 Academic Detailing – Supplement 95
Who does academic detailing ## Nurse
## Physician
" Pharmacist (trained in educational outreach)
## Other
Interventions " INTERVENTION: AD (two visits), and GPs from the same practice were seen
together) including use of guidelines, exploration of knowledge and patterns of
current activity, offering clear behavioural objectives, acknowledged areas of
controversy + educational materials including key messages from guidelines.
" CONTROL: Distribution of guidelines through courier or postal system
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: prescribing of antidepressant drugs during intervention and
12 months after intervention.
## Economic outcomes
## Other:
## Positive on:
## Negative on:
" No effect on: When comparing the study groups, there was no significant
impact of the intervention on usage of antidepressants.
Conclusion: Untargeted educational outreach may not be a worthwhile strategy.
96 Academic Detailing – Supplement KCE reports 125
Study number 16. Study included
EPSTEIN, 2008
Epstein JN, Langberg JM, Lichtenstein PK, Mainwaring BA, Luzader CP, Stark LJ. Community-wide intervention to improve the attention-deficit/hyperactivity disorder assessment and treatment practices of community physicians. Pediatrics. 2008;122(1):19-27.
Quality appraisal score " 7/14
Country ## Europe
" US (Cincinnati)
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design ## RCT
## Controlled study (prospective/retrospective):
" Before-after:
## Time series:
Objectives
" To implement and test a quality-improvement intervention aimed at improving community-based primary care providers’ adherence to the American Academy of Pediatrics, evidence-based diagnostic and treatment guidelines for attention-deficit/hyperactivity disorder (ADHD)
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Elementary school aged children with attention-deficit/hyperactivity disorder (ADHD)
Caregiver targeted " Family physician (= general practitioner): 55 practices and 202 GPs.
## Specialist
## Type of physician not specified
Behavior targeted " Improving community-based primary care providers’ adherence to the
KCE Reports 125 Academic Detailing – Supplement 97
American Academy of Pediatrics, evidence-based diagnostic and treatment guidelines for attention-deficit/hyperactivity disorder (ADHD)
Who does academic detailing ## Nurse
" Physician
## Pharmacist
## Other
Interventions " INTERVENTION: Four post-graduate sessions + AD (1-hour) including:
incorporation of evidence-based guidelines + feedback + performance improvement
techniques including small tests of change or plan-do-study-act cycles + tools
including ADHD rating scales, practices were thaught to use a patient log to track
progress of patient, a written care management plan, scripts for assessing
medication responses during telephone interviews with parents + parent handouts
describing ADHD/treatment + algorithm for making ADHD referrals to
behavioural health specialists.
## CONTROL: NA
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: use of guidelines for the assessment and treatment of
ADHD, use of parent and teacher assessment rating scales and systematic
monitoring of responses to medication.
## Economic outcomes
## Other:
" Positive on: After intervention, GPs showed substantial improvement in the
use of guidelines for the assessment and treatment of ADHD. Use of parent and
teacher assessment rating scales increased significantly. Systematic monitoring of
responses to medication improved.
## Negative on:
## No effect on:
Conclusion: Multifaceted QI intervention effective on quality of care for children with ADHD.
98 Academic Detailing – Supplement KCE reports 125
Study number 17. Study included
ETTER, 2006
Etter J-F. Impact of educational outreach visits on smoking cessation activities performed by specialist physicians: a randomized trial. EDUC HEALTH. 2006;19(2):155-65.
Quality appraisal score " 9/14
Country " Europe: Switzerland
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT (post-test only)
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To examine of educational visits by a nurse to specialist physicians improved the self-reporting of smoking cessation activities, whether these visits increased the percentage of physicians who were aware of and recommended a computer-tailored smoking cessation program and who participated in a training workshop on tobacco dependency treatment.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Adults who smoke
Caregiver targeted " Family physician (= general practitioner) ---523 physicians in total with 261
intervention and 262 control.
" Specialists: internists, cardiologists, pneumologists and surgeons
## Type of physician not specified
KCE Reports 125 Academic Detailing – Supplement 99
Behavior targeted " Self-reporting of smoking cessation activities, recommending a computer-
tailored smoking cessation program and participation at a training workshop on
tobacco dependency treatment
Who does academic detailing " Nurse
## Physician
## Pharmacist
## Other
Interventions " INTERVENTION: One 40-minute visit by nurse (former medical sales
representative) including: guidelines and answering questions from physicians +
presentation of computer-based smoking cessation program.
## CONTROL: no intervention
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: percentage of patients the physicans counselled or treated
for tobacco dependency and number of physicians who took part in a workshop.
## Economic outcomes
## Other:
" Positive on: when comparing the intervention groups, the proportion of
physicians who recommended to their patients the use of computer-tailored
smoking cessation program increased + the proportion of patients who received
the advice to quit smoking increased
## Negative on:
" No effect on: The intervention had no impact on the physicians’ participation in
the workshop.
Conclusion: AD positively influences the number of recommendations to use computer
smoking cessation program + advice to quit smoking.
100 Academic Detailing – Supplement KCE reports 125
Study number 18. Study included
FEDER, 1995
Feder G, Griffiths C, Highton C, Eldridge S, Spence M, Southgate L. Do clinical guidelines introduced with practice based education improve care of asthmatic and diabetic patients? A randomised controlled trial in general practices in east London. BMJ. 1995;311(7018):1473-8.
Quality appraisal score " 11/14
Country " Europe: UK (London)
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT (cross-over design)
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To determine whether locally developed guidelines on asthma and diabetes disseminated through practice based education improve quality of care in non-training general practices.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients (adults) with asthma and/or diabetes
Caregiver targeted " Family physician (= general practitioner): 27 practices
## Specialist
## Type of physician not specified
Behavior targeted " Prescribing in asthma, review of inhaler technique, review of asthma
symptoms, glycaemic control, funduscopy, feet examination, weight, smoking habit,
KCE Reports 125 Academic Detailing – Supplement 101
use of structured consultation ‘prompts’
Who does academic detailing " Nurse (specialist nurse)
## Physician
## Pharmacist
## Other
Interventions " INTERVENTION: AD: 3 post-graduate education sessions + guideline
discussion + practice protocol for implementing guidelines + prompts + practical
discussion on home urine monitoring or peak flow measurement + inhaler
technique + audit + analysis of coping with implementing guidelines
## CONTROL: (cross-over design)
Multifaceted intervention? " YES
Outcomes " Biological outcomes: asthma—peak flow rate, prophylaxis, occupation and
smoking habit/ diabetes: blood glucose concentration
## Psycho-social outcomes
" Process outcomes: prescribing in asthma, review of inhaler technique, review
of asthma symptoms, glycaemic control, funduscopy, feet examination, weight,
smoking habit, use of structured consultation ‘prompts’
" Economic outcomes
" Other: size of practice disease registers
" Positive on: improvements in all seven diabetes variables (see above),
improved recording of review of inhaler technique, smoking habit, and review of
asthma symptoms, quality of prescribing in asthma. The use of structured prompts
was associated with improved recording of four of seven variables on diabetes and
all six variables on asthma.
## Negative on:
" No effect on: sizes of disease registers were unchanged
Conclusion: Practice-based education on the use of guidelines improves the management of
diabetes and asthma in non training practices. The use of prompts may enhance this
improvement.
102 Academic Detailing – Supplement KCE reports 125
Study number 19. Study included
FELDSTEIN, 2006
Feldstein AC, Smith DH, Perrin N, Yang X, Simon SR, Krall M, et al. Reducing warfarin
medication interactions: an interrupted time series evaluation. Arch Intern Med. 2006;166(9):1009-15.
Quality appraisal " 9/14
Country ## Europe
" US
## Canada
## Australia:
## Asia (specify)
Initiator " Nonprofit group model HMO
Design ## RCT
## Controlled study (prospective/retrospective):
## Before-after:
" Time series
Objectives
To measure the effectiveness of electronic medical record alerts and group academic detailing to reduce the coprescribing of Warfarin and interacting medications.
Setting ## Physician’s office
" Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients taking WARFARIN
Caregiver targeted " Family physician (= general practitioner)
## Specialist
## Type of physician not specified
Behavior targeted " Prescription of Warfarin
Who does academic detailing ## Nurse
KCE Reports 125 Academic Detailing – Supplement 103
" Physician
## Pharmacist
## Other
Interventions " INTERVENTION: electronic medical record alerts and group academic
detailing (8 clinics)
" CONTROL: group academic detailing (7clinics)
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: the number of coprescriptions of warfarin-interacting
medications per 10000 Warfarin users per month)
## Economic outcomes
## Other:
" Positive on: reduction in the rate of Warfarin-interacting medication
prescription
## Negative on:
" No effect on: group academic detailing did not enhance alert effectiveness
104 Academic Detailing – Supplement KCE reports 125
Study number 20. Study included
FIGUIERAS, 2001
Figueiras A, Sastre I, Tato F, Rodriguez C, Lado E, Caamano F, et al. One-to-one versus group sessions to improve prescription in primary care: a pragmatic randomized controlled trial. Med Care. 2001;39(2):158-67.
Quality appraisal score " 13/14
Country " Europe: Spain (Galicia)
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design ## RCT
" Controlled study (prospective/retrospective): pragmatic controlled trial
## Before-after:
## Time series:
Objectives
" To evaluate the effectiveness of two educational strategies aimed at improving prescribing standards on NSAID in primary care
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients (adults) with osteoarthrosis with inflammation signs needing NSAIDs
Caregiver targeted " Family physician (= general practitioner)
## Specialist
## Type of physician not specified
Behavior targeted " Prescribing standards on NSAID
Who does academic detailing ## Nurse
## Physician
KCE Reports 125 Academic Detailing – Supplement 105
" Pharmacist (doctoral level)
## Other
Interventions " INTERVENTION I: AD (20 minutes): one-to-one education group (n= 98):
relevant articles + reminder
" INTERVENTION II: a by-group education group (n= 92): 45 minutes by-group
education
" CONTROL: n= 405
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: number of prescribed units of NSAIDs during intervention
## Economic outcomes
## Other:
" Positive on: prescribing behaviour improvement in case of one-to-one
education in the 9 months after intervention. In the education group improvement
was also noted, but significant more improvement in one-to-one education group.
Reminder increased significantly the effectiveness of the one-to-one intervention.
## Negative on:
## No effect on:
Conclusion: proscribing standards can be improved through educational sessions with one-to-
one education to be most effective.
106 Academic Detailing – Supplement KCE reports 125
Study number 21. Study included
FIGUIERAS, 2006
Figueiras A, Herdeiro MT, Polonia J, Gestal-Otero JJ. An educational intervention to improve physician reporting of adverse drug reactions: a cluster-randomized controlled trial. JAMA. 2006;296(9):1086-93.
Quality appraisal score " 13/14
Country " Europe: Portugal
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT (cluster randomized trial)
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To evaluate the effectiveness of educational outreach visits for improving adverse drug reaction (ADR) reporting in physicians.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Not specified (not applicable)
Caregiver targeted " Family physician (= general practitioner): 1388 intervention (4 clusters); 5063
control (11 clusters)
## Specialist
## Type of physician not specified
Behavior targeted " Adequate reporting of ADRs
KCE Reports 125 Academic Detailing – Supplement 107
Who does academic detailing ## Nurse
## Physician
## Pharmacist
## Other
" NA
Interventions " INTERVENTION: 1 hour and 2-part session =AD (outreach visit) + reminder
card + report form---but provided in groups of 10 to 20 physicians! Special focus on
attitudes associated with underreporting + educational materials (essential
messages on ADRs)
## CONTROL:
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: reporting of ADRs
## Economic outcomes
## Other:
" Positive on: increase in ADR reporting rates attributable to intervention for
total ADRs, serious ADRs, high causality ADRs and unexpected ADRs for new
drugs-related ADRs with the greatest difference to occur 4 months after
intervention, and differences to remain statistically significant for 12 months.
## Negative on:
## No effect on:
Conclusion: A targeted outreach program may improve high-quality reporting of ADRs among
physicians.
108 Academic Detailing – Supplement KCE reports 125
Study number 22. Study included
FRANZINI, 2007
Franzini L, Boom J, Nelson C. Cost-effectiveness analysis of a practice-based immunization education intervention. Ambul Pediatr. 2007;7(2):167-75.
Quality appraisal score " 7/14
Country ## Europe
" US: Houston
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT—pre-intervention/post-intervention study
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives " To improve immunization coverage in communities through the
implementation and evaluation of the Raising Immunizations Thru Education (RITE) program
Setting " Physician’s office
## Primary care clinic
## Other
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Children needing immunization aged 12-23 months
Caregiver targeted " Family physician (= general practitioner): 189 practices
" Specialist (paediatric)
## Type of physician not specified
Behavior targeted " Improving immunization coverage
Who does academic detailing ## Nurse
KCE Reports 125 Academic Detailing – Supplement 109
" Physician + team
## Pharmacist
## Other
Interventions " INTERVENTION: Peer-based (1-hour) educational lunch presentation (not-
one-to-one) with three topics + educational materials + recinforcements every
months (during six months)
## CONTROL:
Multifaceted intervention? " YES
Outcomes " Biological outcomes: immunization rates of children aged 12-23 months
## Psycho-social outcomes
" Process outcomes: self-reported provider behaviours (11 items)
aged 12-23 months
" Economic outcomes: cost of the intervention
## Other:
" Positive on: improvements of self-reported provider behavior
" Negative on: costs—no favourable cost-benefit ratio
" No effect on: Immunization rates
Conclusion: the costs for one child with up-to-date immunization status are higher than
potential societal savings.
110 Academic Detailing – Supplement KCE reports 125
Study number 23. Study included
FREEMANTLE, 2002
Freemantle N, Nazareth I, Eccles M, Wood J, Haines A, Evidence-based OutReach t. A randomised controlled trial of the effect of educational outreach by community pharmacists on prescribing in UK general practice. Br J Gen Pract. 2002;52(477):290-5.
Quality appraisal score " 12/14
Country " Europe: UK
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT: cross-over block design
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To evaluate the effectiveness of AD in primary care practices in implementing 4 evidence-based guidelines.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Adults needing ACE inhibitors, raised cardiovascular risk patients needing
aspirin, NSAIDs needing patients with joint pain, patients needing antidepressants.
Caregiver targeted " Family physician (= general practitioner): four practices
## Specialist
## Type of physician not specified
Behavior targeted " Adherence to guidelines: prescription
KCE Reports 125 Academic Detailing – Supplement 111
Who does academic detailing ## Nurse
## Physician
" Pharmacist
## Other
Interventions " INTERVENTION: AD (4 practice visits) including role-play and practice
orientation, guideline discussion, investigation of potential barriers to change +
incentive= audit at the end of project.
## CONTROL:
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: prescription of ACE inhibitors with loop diuretics to
patients suffering from heart failure, aspirin, NSAIDs and antidepressants.
## Economic outcomes
## Other:
" Positive on: AD was associated with a significant improvement in prescribing
practice and an increase in the number of patients treated within the guideline
recommendations.
## Negative on:
## No effect on:
Conclusion: There is good evidence to support the use of educational outreach in small
practices.
112 Academic Detailing – Supplement KCE reports 125
Study number 24. Study included
FRETHEIM, 2006
Fretheim A, Oxman AD, Havelsrud K, Treweek S, Kristoffersen DT, Bjorndal A. Rational prescribing in primary care (RaPP): a cluster randomized trial of a tailored intervention. PLoS Med. 2006;3(6):e134.
Quality appraisal score " 13/14
Country " Europe: Norway
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To evaluate the effectiveness of a tailored intervention to passive dissemination of guidelines
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients needing antihypertensive medication (only those patients were
included in the cost-effectiveness study)
Caregiver targeted " Family physician (= general practitioner): intervention= 69 practices and 244
physicians; Control= 70 practices and 257 physicians.
## Specialist
## Type of physician not specified
KCE Reports 125 Academic Detailing – Supplement 113
Behavior targeted " Prescription of hypertensive drugs according to guidelines
Who does academic detailing ## Nurse
## Physician
" Pharmacist
## Other
Interventions " INTERVENTION: AD + audit+ feedback + computerized reminders linked to
the medical record system
## CONTROL:
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: a) proportions of first-time prescriptions for hypertension
where thiazides were prescribed + b) patients assessed for cardiovascular risk
before prescribing antihypertensive or cholesterol-lowering drugs, c) patients
treated for hypertension or hypercholesterolemia for 3 months or more who had
achieved recommended treatment goals.
## Other:
" Positive on: Significant shift in prescribing of hypertensive drugs towards the
use of thiazides,
## Negative on:
" No effect on: Little or no differences were found for risk assessment prior to
prescribing and for achievement of treatment goal.
Conclusion: intervention had a significant impact on prescribing hypertensive drugs, but was
ineffective in improving the quality of other aspects of managing hypertension and
hypercholesterolemia in primary care.
114 Academic Detailing – Supplement KCE reports 125
Study number 25. Study included
FRETHEIM, 2006
(cost article)
Fretheim A, Aaserud M, Oxman AD. Rational prescribing in primary care (RaPP): economic evaluation of an intervention to improve professional practice. PLoS Med. 2006;3(6):e216.
Quality appraisal score " 13/14
Country " Europe: Norway
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To assess the costs and cost-effectiveness on data from a randomized controlled trial
Setting ## Physician’s office
## Primary care clinic
## Other (specify):
Not applicable
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients needing antihypertensive medication (only those patients were
included in the cost-effectiveness study)
Caregiver targeted " Family physician (= general practitioner): intervention= 69 practices and 244
physicians; Control= 70 practices and 257 physicians.
## Specialist
## Type of physician not specified
KCE Reports 125 Academic Detailing – Supplement 115
Behavior targeted " Prescription of hypertensive drugs according to guidelines
Who does academic detailing ## Nurse
## Physician
" Pharmacist
## Other
Interventions " INTERVENTION: AD + audit+ feedback + computerized reminders
## CONTROL:
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
## Process outcomes
" Economic outcomes: cost-effectiveness of the intervention
## Other:
" Positive on: Significant shift in prescribing of hypertensive drugs towards the
use of thiazides, and thus cost-lowering effects predicted over a two year period.
## Negative on:
## No effect on:
Conclusion: The cost of the intervention was more than twice the savings within the time
frame of the study. Modest savings were predicted.
116 Academic Detailing – Supplement KCE reports 125
Study number 26. Study included
FRIJLING, 2003
Frijling BD, Lobo CM, Hulscher ME, Akkermans RP, van Drenth BB, Prins A, et al. Intensive support to improve clinical decision making in cardiovascular care: a randomised controlled trial in general practice. Qual Saf Health Care. 2003;12(3):181-7.
Quality appraisal score " 11/14
Country " Europe: The Netherlands
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives " To evaluate the effects of outreach visits combined with feedback reports on
the clinical decision making of GPs in cardiovascular care.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
" Heart failure + hypertension, hypercholesterolemia and angina pectoris
## Neurodegenerative diseases
## Respiratory diseases
Caregiver targeted " Family physician (= general practitioner): 124 practices
## Specialist
## Type of physician not specified
Behavior targeted " Compliance rates for 12 evidence-based indicators for the management of
patients with hypertension, hypercholesterolemia, angina pectoris or heart failure.
Who does academic detailing ## Nurse
KCE Reports 125 Academic Detailing – Supplement 117
## Physician
## Pharmacist
" Other: non physicians not specified
Interventions " INTERVENTION: outreach visits (7) including discussion of feedback reports,
selection of clinical issues for improvement, selection of methods to achieve
change, provision of materials and advice, provision of a reminder and evaluation.
" CONTROL: no intervention
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: assessment of risk factors in patients with
hypercholesterolemia, angina pectoris, hypertension and heart failure.
## Economic outcomes
## Other:
" Positive on: significant improvement when comparing the intervention arms
was found for: the assessment of risk factors in patients with hypercholesterolemia
and angina pectoris, provision of information and advice to patients with
hypercholesterolemia and hypertension, checking for clinical signs of deterioration
in patients with heart failure.
## Negative on:
## No effect on:
Conclusion: Intensive support from trained non-physicians can alter certain aspects of the
clinical decision making of GPs in cardiovascular care, although the effect is small.
118 Academic Detailing – Supplement KCE reports 125
Study number 27.
GANDJOUR, 2005
Gandjour A, Lauterbach KW. How much does it cost to change the behavior of health professionals? A mathematical model and an application to academic detailing. Medical Decision Making. 2005;25(3):341-7.
Quality appraisal score ## Not applicable
Country " Europe: Germany
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design ## RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
" Other: mathematical model
Objectives " To portray the mathematical relationship between the proportion of patients
who lack appropriate care due to non-compliance of health professionals and the costs of convincing health professionals to promote appropriate care.
Setting ## Physician’s office
## Primary care clinic
" Other (specify): NA
Population targeted ## Cancer
" Heart failure: coronary heart failure (hypertension)
## Neurodegenerative diseases
## Respiratory diseases
" Stroke
Caregiver targeted " Family physician (= general practitioner)
## Specialist
## Type of physician not specified
KCE Reports 125 Academic Detailing – Supplement 119
Behavior targeted " Prescription of antihypertensive drugs
Who does academic detailing ## Nurse
## Physician
## Pharmacist
" Other: not specified
Interventions " INTERVENTION: outreach visits to improve prescription
## CONTROL:
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
## Process outcomes
" Economic outcomes
## Other:
## Positive on:
## Negative on:
## No effect on:
Conclusion: Marginal implementation costs are directly proportional to the natural logarithm
of the size of the current quality deficit. If outreach educators were to visit all primary care
physicians in Germany to improve the prescription of hypertensive drugs, the annual
implementation cost would total 238 EUR million, or 0,2% of the health insurance total budget
(same goes for coronary heart disease). Implementation costs may not have a critical impact on
the cost-effectiveness ratio of preventive services through AD.
120 Academic Detailing – Supplement KCE reports 125
Study number 28. Study included
GOLDBERG, 1998
Goldberg HI, Wagner EH, Fihn SD, Martin DP, Horowitz CR, Christensen DB, et al. A randomized controlled trial of CQI teams and academic detailing: can they alter compliance with guidelines? Jt Comm J Qual Improv. 1998;24(3):130-42.
Quality appraisal score " 12/14
Country ## Europe
" US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives " To determine the effectiveness of AD techniques and continuous quality
improvement teams in increasing compliance with national guidelines for the primary care of hypertension and depression.
Setting ## Physician’s office
" Primary care clinic (four primary care clinics)
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with hypertension and depression
Caregiver targeted " Family physician (= general practitioner): 15 small group practices
## Specialist
## Type of physician not specified
Behavior targeted " Compliance with national guidelines for the primary care of hypertension and
depression.
KCE Reports 125 Academic Detailing – Supplement 121
##
Who does academic detailing ## Nurse
" Physician
## Pharmacist
## Other
Interventions " INTERVENTION: AD (15 minutes) by physician + educational materials +
follow-up sessions by pharmacists during which computer-generated profiles
comparing provider prescribing patterns
" INTERVENTION: AD + CQI teams
" CONTROL: usual care
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: percentage of depressives prescribed first-generation
tricyclics
## Economic outcomes
## Other:
" Positive on: percentage of depressives prescribed first-generation tricyclics
increased
## Negative on:
" No effect on: CQI-teams and AD in combination
Conclusion: The AD techniques and the CQI teams evaluated were generally
ineffective in improving guideline compliance and clinical outcomes regarding the
primarycare of hypertension and depression.
122 Academic Detailing – Supplement KCE reports 125
Study number 29. Study included
GOMEL, 1998 (cost-article)
Gomel MK, Wutzke SE, Hardcastle DM, Lapsley H, Reznik RB. Cost-effectiveness of strategies to market and train primary health care physicians in brief intervention techniques for hazardous alcohol use. Soc Sci Med. 1998;47(2):203-11.
Quality appraisal score " 10/14
Country ## Europe
## US
## Canada
" Australia: Sydney
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives " To evaluate the cost-effectiveness of an intervention targeting GPs in
improving the management of hazardous alcohol consumption.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" People with hazardous alcohol consumption
Caregiver targeted " Family physician (= general practitioner): 127 + 34 control
## Specialist
## Type of physician not specified
Behavior targeted " Management of hazardous alcohol consumption (screening and counselling
rates)
KCE Reports 125 Academic Detailing – Supplement 123
Who does academic detailing ## Nurse
## Physician
" Pharmacist
## Other
Interventions " INTERVENTION: Training and no support for uptake of the “Drink-less
package” (direct mail): 35
" INTERVENTION: Training and minimal support for uptake of the “Drink-less
package” (tele-marketing): 45 + reminders
" INTERVENTION: Training and maximal support for uptake of the “Drink-less
package” –practice visits every two weeks (AD): 40
" CONTROL: 42 (no training or support)
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: screening and counselling rates.
" Economic outcomes: cost-effectiveness
## Other:
" Positive on: Update of the intervention package and recruitment rates better
for AD compared to direct mail and tele-marketing. Tele-marketing was found to
be more cost-effective than AD and direct mail in promoting the update of the
package to improve screening and counselling for hazardous alcohol consumption.
## Negative on:
## No effect on:
Conclusion: Tele-marketing was found to be more cost-effective than AD and
direct mail in promoting the update of the package to improve screening and
counselling for hazardous alcohol consumption.
124 Academic Detailing – Supplement KCE reports 125
Study number 30. Study included
GONZALES, 1999
Gonzales R, Steiner JF, Lum A, Barrett PH, Jr. Decreasing antibiotic use in ambulatory practice: impact of a multidimensional intervention on the treatment of uncomplicated acute bronchitis in adults. JAMA. 1999;281(16):1512-9.
Quality appraisal score " 13/14
Country ## Europe
" US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design ## RCT
" Controlled study (prospective) but non-randomized
## Before-after
## Time series:
Objectives " To decrease total antibiotic use for uncomplicated acute bronchitis in adults
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with uncomplicated acute bronchitis
Caregiver targeted " Family physician (= general practitioner): 56 physicians+ 2462 adults
## Specialist
## Type of physician not specified
Behavior targeted " Prescription of antibiotics
Who does academic detailing ## Nurse
## Physician
## Pharmacist
KCE Reports 125 Academic Detailing – Supplement 125
" Not specified
Interventions " INTERVENTION: AD (not clearly described) + household and office-based
patient educational materials, education, practice profiling
" INTERVENTION LIMITED:
" CONTROL: office-based educational materials
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: antibiotic prescription rates, return office visits within 30
days of the incident visit
## Economic outcomes
## Other:
" Positive on: substantial decline in antibiotic prescription rates in intervention
group, but not at the control and limited intervention group.
## Negative on:
" No effect on: Return office visits within 30 days of the incident visit for
bronchitis or pneumonia did not change significantly for any of the sites
Conclusion: Antibiotic treatment of adults diagnosed with uncomplicated bronchitis can be
reduced using a combination of patient and clinician interventions
126 Academic Detailing – Supplement KCE reports 125
Study number 31. Study included
GRAHAM, 2008
Graham SD, Hartzema AG, Sketris IS, Winterstein AG. Effect of an academic detailing intervention on the utilization rate of cyclooxygenase-2 inhibitors in the elderly. Ann Pharmacother. 2008;42(6):749-56.
Quality appraisal score " 11/14
Country ## Europe
## US
" Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design ## RCT
## Controlled study (prospective/retrospective):
" Before-after: Retrospective cohort, before/after design
## Time series:
Objectives
" To evaluate the effect of a GP targeted osteoarthritis AD intervention on a reduction in the prescribing of cyclooxygenase-2 (COX-2) inhibitors, as well as examine the intervention effect on the utilization rates of gastroprotective agents and medical services.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with osteoarthritis
Caregiver targeted " Family physician (= general practitioner)
## Specialist
## Type of physician not specified
Behavior targeted " Reduction in the prescribing of cyclooxygenase-2 (COX-2) inhibitors, as well as
examine the intervention effect on the utilization rates of gastroprotective agents and medical services.
KCE Reports 125 Academic Detailing – Supplement 127
Who does academic detailing " Nurse (1)
## Physician
" Pharmacist (3)
## Other
Interventions " INTERVENTION: AD (interactive)
## CONTROL: usual care
Multifaceted intervention? " NO
Outcomes " Biological outcomes: patient morbidity and mortality
## Psycho-social outcomes
" Process outcomes: change in COX-2 utilization rates from baseline, office visits
rates visits/patients, use of protein pump inhibitor, mesoprostol and histamine2-
receptor antagonist, GP office visits per patient, specialist office visits per patient
and death rates per GP due to gastrointestinal complications
## Economic outcomes
## Other:
" Positive on: The osteoarthritis AD intervention was associated with a
significant decrease in COX-2 utilization rates in the 3-month period immediately
following the intervention.
## Negative on:
" No effect on: measures of patient morbidity and mortality due to
gastrointestinal complications
Conclusion: AD yield both positive outcomes and no outcomes.
128 Academic Detailing – Supplement KCE reports 125
Study number 32. Study included
GRIFFITHS, 2004 Griffiths C, Foster G, Barnes N, Eldridge S, Tate H, Begum S, et al. Specialist
nurse intervention to reduce unscheduled asthma care in a deprived multiethnic area: the east London randomised controlled trial for high risk asthma (ELECTRA). BMJ. 2004;328(7432):144.
Quality appraisal score " 12/14
Country " Europe: UK
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT (cluster RCT)
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To determine whether asthma specialist nurses using a liaison model of care reduce unscheduled care in a deprived multiethnic area.
Setting " Physician’s office
" Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
" Respiratory diseases: asthma
Caregiver targeted " Family physician (= general practitioner): 44 practices
## Specialist
## Type of physician not specified
Behavior targeted " Unscheduled care for asthma patients
Who does academic detailing " Nurse (asthma specialist nurses)
## Physician
KCE Reports 125 Academic Detailing – Supplement 129
## Pharmacist
## Other
Interventions " INTERVENTION: patient review in a nurse-led clinic and liaison with GPs
comprising: educational outreach (= AD, not well described), promotion of
guidelines, and ongoing clinical support.
" CONTROL: a visit promoting standard asthma guidelines, and control patients
where checked for inhaler technique.
Multifaceted intervention? " YES
Outcomes " Biological outcomes: rates of attendance for unscheduled care, self-
management behaviour, asthma symptoms
" Psycho-social outcomes: quality of life
" Process outcomes: percentage of participants attending for unscheduled
asthma care and the time to first attendance for unscheduled asthma care in the
year after intervention.
## Economic outcomes
## Other:
" Positive on: delayed time to first attendance when comparing intervention
arms and reduction in the percentage of patients with acute asthma
## Negative on:
" No effect on: quality of life and self-management behaviour and asthma
symptoms
Conclusion: Asthma specialist nurses using a liaison model of care reduced unscheduled care
for asthma.
130 Academic Detailing – Supplement KCE reports 125
Study number 33. Study included
HALL, 2001 Hall L, Eccles M, Barton R, Steen N, Campbell M. Is untargeted outreach
visiting in primary care effective? A pragmatic randomized controlled trial. J Public Health Med. 2001;23(2):109-13.
Quality appraisal score " 13/14
Country " Europe: UK
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives " To evaluate the effectiveness of untargeted outreach visiting in addition to
postal distribution of educational materials.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with helicobacter pylori
Caregiver targeted " Family physician (= general practitioner): 38 practices
## Specialist
## Type of physician not specified
Behavior targeted " Management of helicobacter pylori
Who does academic detailing ## Nurse
## Physician
KCE Reports 125 Academic Detailing – Supplement 131
" Pharmacist
## Other
Interventions " INTERVENTION: guidelines + AD (exploration of knowledge and patterns of
current activity, behavioural objectives, acknowledged areas of controversy +
educational materials + audit
## CONTROL:
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: prescription of three drugs
## Economic outcomes
## Other:
" Positive on: significant increase in omeprazole and metronidazole use
## Negative on:
" No effect on: non-significant change in prescribing of dose units
Conclusion: the routine use of untargeted outreach visiting is probably not a worthwhile
strategy.
132 Academic Detailing – Supplement KCE reports 125
Study number 34. Study included
HENNESSY, 2006 Hennessy S, Leonard CE, Yang W, Kimmel SE, Townsend RR, Wasserstein
AG, et al. Effectiveness of a two-part educational intervention to improve hypertension control: a cluster-randomized trial. Pharmacotherapy. 2006;26(9):1342-7
Quality appraisal score " 13/14
Country ## Europe
" US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT cluster randomized trial)
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To measure the effectiveness of a multifaceted educational intervention to improve ambulatory hypertension control.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with hypertension
Caregiver targeted " Family physician (= general practitioner); 39 intervention group, and 54 control
group.
## Specialist
## Type of physician not specified
Behavior targeted " Ambulatory hypertension control.
KCE Reports 125 Academic Detailing – Supplement 133
Who does academic detailing ## Nurse
## Physician
" Pharmacist
## Other
Interventions " INTERVENTION: AD (20-30 minutes session) + provider-specific audits=
provider specific data about hypertension control, educational materials to the
provider and the patient.
" CONTROL: no intervention
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: proportion of patients achieving blood pressure control
below 140/90 mmHg + secondary analysis in patients with diabetes or kidney
disease—controlled hypertension: 130/80 mmHg
## Economic outcomes
## Other:
## Positive on:
## Negative on:
" No effect on: no effect or moderate effect among patients with hypertension.
Conclusion: AD yield very little or no positive effects in this study.
134 Academic Detailing – Supplement KCE reports 125
Study number 35. Study included
HORN, 2007 Horn FE, Mandryk JA, Mackson JM, Wutzke SE, Weekes LM, Hyndman RJ.
Measurement of changes in antihypertensive drug utilisation following primary care educational interventions. Pharmacoepidemiol Drug Saf. 2007;16(3):297-308.
Quality appraisal score ##
Country ## Europe
## US
## Canada
" Australia:
## Asia (specify)
Initiator " Not specified
Design ## RCT
## Controlled study (prospective/retrospective):
## Before-after:
" Time series: with intervention implemented over a period of 6 to 8 months.
Objectives " To measure changes in drug utilization following a national general practice education
program aimed at improving prescribing for hypertension.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with hypertension
Caregiver targeted " Family physician (= general practitioner)
## Specialist
## Type of physician not specified
Behavior targeted " Changes in drug utilization following a national general practice education
program aimed at improving prescribing for hypertension.
KCE Reports 125 Academic Detailing – Supplement 135
Who does academic detailing ## Nurse
## Physician
## Pharmacist
" Not specified
Interventions " INTERVENTION: newsletters+ prescribing feed-back, AD, clinical audit with
feedback and case studies (paper-based and peer group discussion) over an 6 to 8
months period.
## CONTROL:
## NA
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: use of thiazide or thiazide like diuretics at first line therapy
for hypertension, use of low-dose formulations where thiazide diuretics were used,
use of beta-blockers as first line therapy.
## Economic outcomes
## Other:
" Positive on: increase in low-dose thiazide and beta-blocker prescribing.
## Negative on:
## No effect on:
Conclusion: A national education program aimed at GPs is successful in improving prescribing
for hypertension.
136 Academic Detailing – Supplement KCE reports 125
Study number 36. Study included
HULSCHER, 1997 Hulscher ME, van Drenth BB, van der Wouden JC, Mokkink HG, van Weel C,
Grol RP. Changing preventive practice: a controlled trial on the effects of outreach visits to organise prevention of cardiovascular disease. Qual Health Care. 1997;6(1):19-24.
Quality appraisal score " 11/14
Country " Europe: The Netherlands
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design ## RCT
" Controlled study (prospective/retrospective): non randomized controlled trial
## Before-after:
## Time series:
Objectives
" To assess the effects of outreach visits by trained nurse facilitators on the organization of services used to prevent cardiovascular disease.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with cardiovascular disease
Caregiver targeted " Family physician (= general practitioner): 95 general practices
## Specialist
## Type of physician not specified
Behavior targeted " Prevention of cardiovascular disease
Who does academic detailing " Nurse
KCE Reports 125 Academic Detailing – Supplement 137
## Physician
## Pharmacist
## Other
Interventions " INTERVENTION: Outreach visits (multiple visits with a total of 30 hours with
25 practice visits over an 18-month period; duration of one visit= 73 minutes) +
practice feedback report + action plan for improvement + educational tools +
" CONTROL: feedback
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: prevention of cardiovascular disease
## Economic outcomes
## Other:
" Positive on: Outreach visits were more effective than feedback in
implementing guidelines to organise prevention. The increase in the number of
practices adhering to the guidelines was significant for six out of 10 guidelines
## Negative on:
" No effect on: the number of practices adhering to the guideline to make a
follow up appointment did not reach significance
Conclusion: Outreach visits by trained nurse facilitators proved to be effective in
implementing guidelines within general practices.
138 Academic Detailing – Supplement KCE reports 125
Study number 37. Study included
ILETT, 2000 Ilett KF, Johnson S, Greenhill G, Mullen L, Brockis J, Golledge CL, et al.
Modification of general practitioner prescribing of antibiotics by use of a therapeutics adviser (academic detailer). Br J Clin Pharmacol. 2000;49(2):168-73.
Quality appraisal score " 13/14
Country ## Europe
## US
## Canada
" Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To evaluate the effectiveness of AD to modify antibiotic prescribing by general practitioners
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with upper and lower respiratory tract infections, otitis media and
urninary tract infections.
Caregiver targeted " Family physician (= general practitioner): 112; 56 intervention; 56 control
## Specialist
## Type of physician not specified
Behavior targeted " Antibiotic prescribing by general practitioners
KCE Reports 125 Academic Detailing – Supplement 139
Who does academic detailing ## Nurse
## Physician
" Pharmacist
## Other
Interventions " INTERVENTION: AD (10-15 minutes) + educational materials (including
guidelines)
## CONTROL: usual care
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: total number of prescriptions for selected individual
antibiotics
" Economic outcomes: costs
## Other:
" Positive on: when comparing the interventions arms, GPs in the intervention
group prescribed amoxicillin and doxycilline (complied to guidelines) + positive
effect on total costs of antibiotics
## Negative on:
## No effect on:
Conclusion: AD is successful in modifying prescribing patterns, and it also decreased
prescription numbers and costs.
140 Academic Detailing – Supplement KCE reports 125
Study number 38. Study included
JACKSON, 2004 Jackson SL, Peterson GM, Vial JH. A community-based educational
intervention to improve antithrombotic drug use in atrial fibrillation. Ann Pharmacother. 2004;38(11):1794-9.
Quality appraisal score " 11/14
Country ## Europe
## US
## Canada
" Australia:
## Asia (specify)
Initiator " Not specified
Design ## RCT
" Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To assess the effectiveness of AD in reducing the risk of stroke through the use of antithombotics in patients with atrial fibrillation
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with atrial fibrillation and an elevated risk to develop stroke
Caregiver targeted " Family physician (= general practitioner)
## Specialist
## Type of physician not specified
Behavior targeted " Reducing the risk of stroke through the use of antithrombotics (Warfarin) in
patients with atrial fibrillation
KCE Reports 125 Academic Detailing – Supplement 141
Who does academic detailing ## Nurse
## Physician
" Pharmacist
## Other
Interventions " INTERVENTION: AD + educational materials (guidelines)
## CONTROL:
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: prescription of Warfarin and aspirin
## Economic outcomes
## Other:
" Positive on: when comparing intervention arms: increased use of Warfarin in
patient at high risk of stroke.
## Negative on:
## No effect on:
Conclusion: the educational program led to a significant increase in the prescribing of
Warfarin for stroke prevention in patients with AF
142 Academic Detailing – Supplement KCE reports 125
Study number 39. Study included
KIM, 1999 Kim CS, Kristopaitis RJ, Stone E, Pelter M, Sandhu M, Weingarten SR.
Physician education and report cards: do they make the grade? results from a randomized controlled trial. Am J Med. 1999;107(6):556-60.
Quality appraisal score " 13/14
Country ## Europe
" US (California)
## Canada
## Australia:
## Asia (specify)
Initiator " Kaiser Permanente woodland Hills
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives " To evaluate the effectiveness of a comprehensive QI program on the provision
of preventive care services and patient satisfaction.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients needing immunization, mammography and clinical breast
examination
Caregiver targeted " Family physician (= general practitioner): 48 physicians
## Specialist
## Type of physician not specified
Behavior targeted " Provision of preventive care services
Who does academic detailing ## Nurse
KCE Reports 125 Academic Detailing – Supplement 143
## Physician
" Pharmacist
## Other
Interventions " INTERVENTION: comprehensive intervention: educational reminders, peer-
comparison feedback + AD (= at beginning of study and after 6 and 12 months,
duration of 15 minutes)
" CONTROL: education only= mailed educational materials
Multifaceted intervention? " YES
Outcomes " Biological outcomes: rates of reported mammography
## Psycho-social outcomes
" Process outcomes
## Economic outcomes
" Other: number of patients who reported to have received preventive care
services (influenza, pneumococcal, tetanus immunization, exercise counselling)
" Positive on: positive evolution in the number of influenza, pneumococcal, and
tetanus immunization in both intervention and control. Mammography and clinical
breast examination worsened in the education group only. Patient satisfaction
scores improved in intervention group, but no significant result
## Negative on:
## No effect on:
Conclusion: multifaceted intervention has modest effects on patient satisfaction and possibly
on the offering of selected preventive care services.
144 Academic Detailing – Supplement KCE reports 125
Study number 40. Study included
LEMELIN, 2001 Lemelin J, Hogg W, Baskerville N. Evidence to action: a tailored multifaceted approach to changing family physician practice patterns and improving preventive care. CMAJ. 2001;164(6):757-63.
Quality appraisal score " 13/14
Country ## Europe
## US
" Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives " To evaluate the effectiveness of a multifaceted intervention on preventive
performance of practices
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients needing preventive actions
Caregiver targeted " Family physician (= general practitioner): 23 practices intervention/ 23
practices control
## Specialist
## Type of physician not specified
Behavior targeted " Improved prevention: folic acid supplementation, smoking cessation and
hypertension treatment
KCE Reports 125 Academic Detailing – Supplement 145
Who does academic detailing " Nurse
## Physician
## Pharmacist
## Other
Interventions " INTERVENTION: guidelines + AD (21-50 times) with average visit length of 1
hour and 45 minutes + audit and ongoing feedback + consensus building+ opnion
leaders and network + reminders systems + patient-mediated activities + patient
educational materials.
" CONTROL: no intervention
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: folic acid supplementation, smoking cessation and
hypertension treatment (index of preventive performance)
## Economic outcomes
## Other:
" Positive on: when comparing intervention and control: index of preventive
performance significantly better in intervention group +proportion of patients who
received recommended preventive services
## Negative on:
" No effect on: index of preventive performance
Conclusion: Multifaceted intervention delivered by nurse facilitators effective on
modifying physician practice patterns and preventive performance.
146 Academic Detailing – Supplement KCE reports 125
Study number 41. Study included
LIN, 1997 Lin EH, Katon WJ, Simon GE, Von Korff M, Bush TM, Rutter CM, et al.
Achieving guidelines for the treatment of depression in primary care: is physician education enough? Med Care. 1997;35(8):831-42.
Quality appraisal score " 10/14
Country ## Europe
" US (Washington)
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design ## RCT
## Controlled study (prospective/retrospective):
" Before-after: quasi-experimental and before/after comparisons
## Time series:
Objectives " To evaluate if physician education has enduring effects on the treatment of
depression.
Setting " Physician’s office
" Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with depression
Caregiver targeted " Family physician (= general practitioner): 22
" Specialist: general internists
## Type of physician not specified
Behavior targeted " Management of depression
Who does academic detailing ## Nurse
KCE Reports 125 Academic Detailing – Supplement 147
## Physician
## Pharmacist
## Other
" Not specified
Interventions " INTERVENTION: AD + guidelines, role-play of improved practices, review of
patient education pamphlets and videotapes, use of a reference handbook on
depression) + reorganizing of services + criteria for urgent psychiatric referrals and
case reviews with psychiatric consultants.
## CONTROL: NA
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
" Psycho-social outcomes: patient satisfaction and depression outcomes
" Process outcomes: physician selection of antidepressant medication, adequacy
of pharmacotherapy, intensity and follow-up visits during the acute phase of
depression treatment.
## Economic outcomes
## Other:
## Positive on:
## Negative on:
" No effect on: no improvement in any of the outcomes measured.
Conclusion: No effect of multifaceted intervention including AD
148 Academic Detailing – Supplement KCE reports 125
Study number 42. Study included
LIN, 2001 Lin EH, Simon GE, Katzelnick DJ, Pearson SD. Does physician education on
depression management improve treatment in primary care? Journal of General Internal Medicine. 2001;16(9):614-9.
Quality appraisal score " 12/14
Country ## Europe
" US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design ## RCT
## Controlled study (prospective/retrospective):
" Before-after: before/after comparisons
## Time series:
Objectives " To assess the effect of physician education on the management of depression.
Setting " Physician’s office
" Primary care clinic: 15
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with depression
Caregiver targeted " Family physician (= general practitioner): 109
" Specialist: general internists
## Type of physician not specified
Behavior targeted " Management of depression
Who does academic detailing ## Nurse
## Physician
KCE Reports 125 Academic Detailing – Supplement 149
## Pharmacist
## Other
" Not specified
Interventions " INTERVENTION: Small group interactive discussions+ expert demonstrations
+ role-play, AD of pharmacotherapy + criteria for urgent psychiatric referrals and
case reviews with psychiatric consultants + case based feedback
## CONTROL: usual care
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
" Psycho-social outcomes:
" Process outcomes: new diagnoses per 100 primary care visits, new
antidepressant medications per 100 visits, rate of new diagnosis accompanied by a
new prescription per 100 visits, duration of pharmacotherapy
## Economic outcomes
## Other:
## Positive on:
## Negative on:
" No effect on: no difference between intervention and control in the rate of new
depression diagnosis, new prescription of antidepressant medicines
Conclusion: No effect of multifaceted intervention including AD on depression diagnosis or
phamacotherapy
150 Academic Detailing – Supplement KCE reports 125
Study number 43. Study included
LOBO, 2002 Lobo CM, Frijling BD, Hulscher MEJL, Braspenning JC, Grol RPTM, Prins A, et
al. Organizing cardiovascular preventive care in general practice: determinants of a successful intervention.[see comment]. Prev Med. 2002;35(5):430-6.
Quality appraisal score " 12/14
Country " Europe: The Netherlands
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To determine determinants of success of outreach visiting to optimizing cardiovascular preventive care.
Setting ## Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients needing cardiovascular preventive care
Caregiver targeted " Family physician (= general practitioner): 62 intervention, 62 control
## Specialist
## Type of physician not specified
Behavior targeted " Cardiovascular preventive care.
##
KCE Reports 125 Academic Detailing – Supplement 151
Who does academic detailing ## Nurse
## Physician
## Pharmacist
" Other: project team member
Interventions " INTERVENTION: Outreach visits--15 (practice organization and clinical
decision making, goal-setting)
" CONTROL: no intervention
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
## Process outcomes
## Economic outcomes
" Other: deficiency score (the difference between ideal and actual practice)
" Positive on: the duration of exposure was positively related to the change in
availability of separate clinics and in the amount of teamwork. The improvement in
instruments and materials was positively related to the GP’s opnion about the
given feedback.
## Negative on:
" No effect on: No relations were found between key characteristics and changes
in record-keeping or follow-up routines.
Conclusion: Disentagling the ‘black box’ of an outreach visit intervention is difficult.
152 Academic Detailing – Supplement KCE reports 125
Study number 44. Study included
LOBO, 2002
Lobo CM, Frijling BD, Hulscher MEJL, Bernsen RMD, Braspenning JC, Grol RPTM, et al. Improving quality of organizing cardiovascular preventive care in general practice by outreach visitors: a randomized controlled trial.[see comment]. Prev Med. 2002;35(5):422-9.
Quality appraisal score " 13/14
Country " Europe: The Netherlands
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To determine determinants of success of outreach visiting to optimizing cardiovascular preventive care.
Setting ## Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients needing cardiovascular preventive care
Caregiver targeted " Family physician (= general practitioner): 62 intervention, 62 control
## Specialist
## Type of physician not specified
Behavior targeted " Cardiovascular preventive care.
##
KCE Reports 125 Academic Detailing – Supplement 153
Who does academic detailing ## Nurse
## Physician
## Pharmacist
" Other: project team member
Interventions " INTERVENTION: Outreach visits—15 over 21-month period (practice
organization and clinical decision making, goal-setting)
" CONTROL: no intervention
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: preventive tasks performed by the practice assistant
(measurements taken, history questions asked, advice given on), follow-up including
making an appointment immediately after the visit, making an identifiable note,
providing an appointment car for patients.
## Economic outcomes
" Other: availability of instruments and materials (e.g. blood pressure meter,
glucose meter,...), leaflets, adequate ancillary staff present, separate room for
practice assistant, teamwork in the practice, record keeping.
" Positive on: when comparing the intervention arms, the difference in change
was statistically significant for each aspect of organizing preventive care. The
largest absolute improvement was found for the number of preventive tasks
performed by the practice assistant.
## Negative on:
## No effect on:
Conclusion: AD is effective in improving organization of cardiovascular preventive
care.
154 Academic Detailing – Supplement KCE reports 125
Study number 45. Study included
MANFREDI, 1998
Manfredi C, Czaja R, Freels S, Trubitt M, Warnecke R, Lacey L. Prescribe for health. Improving cancer screening in physician practices serving low-income and minority populations. Arch Fam Med. 1998;7(4):329-37.
Quality appraisal score " 13/14
Country ## Europe
" US: Chicago
## Canada
## Australia:
## Asia (specify)
Initiator " HMO
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To evaluate the effectiveness of a Health Maintenance Organization (HMO)-sponsored intervention to improve cancer screening in private physician practices serving low-income, minority populations.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted " Cancer (breast, cervical and colorectal cancers)
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
Caregiver targeted " Family physician (= general practitioner): 87 intervention;
## Specialist
## Type of physician not specified
Behavior targeted " Screening of cancer (breast, cervical and colorectal cancers)
Who does academic detailing ## Nurse
## Physician
KCE Reports 125 Academic Detailing – Supplement 155
## Pharmacist
" Not specified
Interventions " INTERVENTION: Outreach visits (2; within 2 months of initial training) + chart
reminder system to identify patients in need of cancer screening + guidelines +
patient educational materials + awareness materials + on-site training of staff +
CME seminars for physicians + feedback
" CONTROL:
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: the proportions of patients with a chart-documented
mammogram, clinical breast examination, Papanicolauo smear and occult blood
slide test in 2 years before preintervention and postintervention chart abstractions.
## Economic outcomes
## Other:
" Positive on: between baseline and postinterventions, there was a net increase
in the proportion of HMO members in the intervention, compared to control
practices for Papanicolauo smear and fecal occult blood slide test. There was a net
increase in the proportion of non-HMO patients in the intervention compared with
the control practices who received clinical breast examination and a fecal blood
slide test.
## Negative on:
## No effect on:
Conclusion: Multifaceted intervention, including outreach visits affective on
improving cancer screening
156 Academic Detailing – Supplement KCE reports 125
Study number 46.
MASON, 2001
Mason J, Freemantle N, Nazareth I, Eccles M, Haines A, Drummond M. When is it cost-effective to change the behavior of health professionals? JAMA. 2001;286(23):2988-92.
Quality appraisal score ## NA
Country " Europe
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " Cost modelling study ---(based on RCT study of Freemantle)
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
" NA
Objectives
" Providing a framework for exploring the economics of influencing physician behaviour (underlying study the one of Freemantle)
Setting ## Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
" Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Depression
Caregiver targeted " Family physician (= general practitioner)
## Specialist
## Type of physician not specified
Behavior targeted " Changes in prescribing medications of ACE inhibitors and SSRIs (selective
serotonin reuptake inhibitor)
KCE Reports 125 Academic Detailing – Supplement 157
Who does academic detailing ## Nurse
## Physician
" Pharmacist
## Other
Interventions ## INTERVENTION:
## CONTROL:
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
## Process outcomes
" Economic outcomes: cost-effectiveness
## Other:
" Positive on: AD is cost-effective for implementation of ACE inhibitors + AD is cost-effective for a reduction in use of SSRIs in favour of triclyclic antidepressants in small practices
## Negative on:
## No effect on:
Conclusion: AD is cost-effective for implementation of ACE inhibitors + AD is cost-effective for a reduction in use of SSRIs in favour of triclyclic antidepressants in small practices
158 Academic Detailing – Supplement KCE reports 125
Study number 47. Study included
McDONALD, 2003
McDonald PK, Winkle CA, Askew D. Evaluation of academic detailing within a coordinated care trial. Journal of Pharmacy Practice and Research. 2003;33(2):114-6.
Quality appraisal score " 7/14
Country ## Europe
## US
## Canada
" Australia
## Asia (specify)
Initiator " Not specified
Design ## RCT
## Controlled study (prospective/retrospective):
" Before-after: quasi-experimental design
## Time series:
Objectives
" To evaluate the effectiveness of AD on general practitioners’ prescribing for heart failure and chronic pain associated with osteoarthritis in an elderly population.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Elderly patients with heart failure and chronic pain associated with
osteoarthritis
Caregiver targeted " Family physician (= general practitioner): 115
## Specialist
## Type of physician not specified
Behavior targeted " Prescribing for heart failure and chronic pain associated with osteoarthritis in
an elderly population.
KCE Reports 125 Academic Detailing – Supplement 159
Who does academic detailing ## Nurse
## Physician
" Pharmacist (teaching-hospital clinical pharmacists)
## Other
Interventions " INTERVENTION: AD visits focusing on key messages (2 visits: 30-minute,
followed by 15-minute visit to reinforce messages) + educational materials
## CONTROL:
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
" Psycho-social outcomes: satisfaction in physicians and pharmacists
" Process outcomes: Prescribing of NSAID, angiotensine converting enzyme
inhibitor and triclyclic antidepressants
## Economic outcomes
## Other:
" Positive on: prescription of NSAID and triclyclic antidepressants
## Negative on:
" No effect on: prescription of angiotensine converting enzyme inhibitor
Conclusion: AD was partly successful in changing prescribing practices for heart failure and
pain management of osteoarthritis
160 Academic Detailing – Supplement KCE reports 125
Study number 48. Study included
MIDLOV ET AL. 2005
Effects of educational outreach visits on prescribing of bezodiazepines and antipsychotic drugs to elderly patients in primary health care in Southern Sweden.
Quality appraisal score " 11/14
Country " Europe (Sweden)
## US
## Canada
## Australia:
## Asia (specify)
Initiator " University
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To evaluate if educational outreach visits to GP practices can affect the prescribing of benzodiazepines and antipsychotic drugs to the elderly and evaluate the opinions of the participating GPs on such education.
Setting of AD " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Elderly needing: benzodiazepines and antipsychotic drugs
Caregiver targeted " Family physician (= general practitioner)
## Specialist
## Type of physician not specified
Behavior targeted " Prescribing of benzodiazepines and antipsychotic drugs
Who does academic detailing ## Nurse
KCE Reports 125 Academic Detailing – Supplement 161
" Physician
" Pharmacist
## Other
Interventions " INTERVENTION: group education programmes (2 sessions) and outreach visit
(2 visits): 8 practices and 23 physicians
" CONTROL: education after study period: 7 practices and 31 physicians
Multifaceted intervention? " YES
## NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: prescribing of medium-and long-acting benzodiazepines and total
benzodiazepines
## Economic outcomes
## Other:
" Positive on: significant decreases in prescribing of medium-and long-acting
benzodiazepines and total benzodiazepines
## Negative on:
" No effect on: decreases in prescribing of antipsychotic drugs
Conclusion: Educational outreach visits are effective in modifying GPs prescribing habits
162 Academic Detailing – Supplement KCE reports 125
Study number 49. Study included
MOLD, 2008
Mold JW, Aspy CA, Nagykaldi Z. Implementation of evidence-based preventive services delivery processes in primary care: An Oklahoma Physicians Resource/Research Network (OKPRN) study. Journal of the American Board of Family Medicine. 2008;21(4):334-44.
Quality appraisal score " 9/14
Country ## Europe
" US
## Canada
## Australia:
## Asia (specify)
Initiator ## Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To assess the effectiveness of a multifaceted program on improved delivery of preventive services.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients needing selected immunizations and preventive services
Caregiver targeted " Family physician + staff of practice (= general practitioner): 12 intervention; 12
control
## Specialist
## Type of physician not specified
Behavior targeted " Improvement of preventive services.
Who does academic detailing ## Nurse
KCE Reports 125 Academic Detailing – Supplement 163
## Physician
## Pharmacist
" Other: principal investigator, practice facilitator and IT-professional
Interventions " INTERVENTION: AD (3 evidence based processes; 90-minute session) +
feedback (report listing the GPs rates of delivery of preventive services--including
DTaPX4, measles/mumps/rubella, HepB for 3 to 3 year olds, pneumonia
vaccination, colorectal cancer screening and mammography for 50-75 year olds +
benchmarking + educational materials + assistance to practices (e.g. training staff +
IT-support)
" CONTROL: Feedback and benchmarking
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: number of practices who implemented one or more of the
evidence-based processes (selected immunizations and preventive services)
+ the number of total processes implemented
## Economic outcomes
## Other:
" Positive on: Intervention practices implemented more of the processes than
control practices overall, for adults and for children. Intervention practices were
also more likely to implement at least one of the processes for children and to
implement standing orders. Mammography rates increased significantly
## Negative on:
## No effect on:
Conclusion: A multicomponent implementation strategy consisting of AD, feedback,
benchmarking, facilitation and IT support increased the implementation of evidence-based
processes for delivering preventive services to a greater extent than performance feedback and
benchmarking alone.
164 Academic Detailing – Supplement KCE reports 125
Study number 50. Study included
MYERS, 2004
Myers RE, Turner B, Weinberg D, Hyslop T, Hauck WW, Brigham T, et al. Impact of a physician-oriented intervention on follow-up in colorectal cancer screening. Prev Med. 2004;38(4):375-81.
Quality appraisal score " 13/14
Country ## Europe
" US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To evaluate the effectiveness of a program directed at improved management of complete diagnostic evaluation (CDE) for persons with an abnormal screening result for fecal occult blood.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Persons with an abnormal screening result for fecal occult blood > 50 years
Caregiver targeted " Family physician (= general practitioner): 470
## Specialist
## Type of physician not specified
Behavior targeted " Improved management of complete diagnostic evaluation (CDE) for persons
with an abnormal screening result for fecal occult blood.
KCE Reports 125 Academic Detailing – Supplement 165
Who does academic detailing " Nurse
## Physician
## Pharmacist
## Other
Interventions " INTERVENTION: screening program + intervention: CDE-reminders + CDE
feedback report + two AD visits (including tailored letter and phone call +
discussion on colorectal cancer screening + educational materials + barriers to CDE
" CONTROL: only screening program + CDE reminders
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: CDE rates for FOBT
## Economic outcomes
## Other:
" Positive on: CDE (complete diagnostic evaluation) recommendation and
performance rates were both significantly higher in the intervention practices
compared to the control practices
## Negative on:
## No effect on:
Conclusion: the reminder-feedback plus educational outreach intervention significantly
increased CDE recommendation and performance
166 Academic Detailing – Supplement KCE reports 125
Study number 51. Study included
NAUGHTON, 2007
Naughton C, Feely J, Bennett K. A clustered randomized trial of the effects of feedback using academic detailing compared to postal bulletin on prescribing of preventative cardiovascular therapy. Fam Pract. 2007;24(5):475-80.
Quality appraisal score " 14/14
Country " Europe: Ireland
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT: cluster randomized trial
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To evaluate the effect of of prescribing feedback on GP practice using AD compared to postal bulletin on prescribing of CVD preventive therapies in patients with CVD or diabtetes at 3 and 6 months post intervention, and to evaluate the intervention from the GP perspective
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with CVD or diabetes
Caregiver targeted " Family physician (= general practitioner): 48 intervention; 50 control
## Specialist
## Type of physician not specified
Behavior targeted " Prescribing of CVD preventive therapies (cardiovascular) in patients with CVD
or diabetes at 3 and 6 months post intervention
KCE Reports 125 Academic Detailing – Supplement 167
Who does academic detailing ## Nurse
## Physician
## Pharmacist
" Other: researcher
Interventions " INTERVENTION: individualized prescribing feedback via AD (= postal bulletin
+ outreach visit). Interactive AD= 15 to 30 minutes + educational materials
" CONTROL: postal bulletin including prescribing feedback
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
" Psycho-social outcomes: satisfaction in GPs
" Process outcomes: level of antiplatelet prescribing in patients with coronary
heart disease, statin prescribing in patients with CVD and, antiplatelet and statin
prescribing in patients with diabetes
## Economic outcomes
## Other:
" Positive on: High level of satisfaction in GPs
## Negative on:
" No effect on: there was a 3% increase in statin prescribing in CVD patients at 6
months post-intervention for both groups, but not statistically significant. Same for:
statin and antiplatelet/warfarin prescribing in diabetic patients
Conclusion: Prescribing preventive therapies increased in both randomized groups, but AD did
not have an additional effect on changing prescribing over the postal bulletin alone.
168 Academic Detailing – Supplement KCE reports 125
Study number 52. Study included
NEW, 2004 New JP, Mason JM, Freemantle N, Teasdale S, Wong L, Bruce NJ, et al.
Educational outreach in diabetes to encourage practice nurses to use primary care hypertension and hyperlipidaemia guidelines (EDEN): a randomized controlled trial. Diabet Med. 2004;21(6):599-603.
Quality appraisal score " 14/14
Country " Europe: UK (Salford)
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT—practice–level randomized controlled trial.
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To determine the effectiveness of specialist nurse delivered education in primary care to improve control of hypertension and hyperlipidemia in patients with diabetes.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with diabetes
Caregiver targeted " Family physician (= general practitioner): 44 practices (10.303 subjects)
## Specialist
## Type of physician not specified
Behavior targeted " Control of hypertension and hyperlipidemia in patients with diabetes.
KCE Reports 125 Academic Detailing – Supplement 169
Who does academic detailing " Nurse (specialist nurses)
## Physician
## Pharmacist
## Other
Interventions " INTERVENTION: AD (intervention targets, measurement methods and work
through case examples) + guidelines + list of patients that were above target +
every three month visits visit to provide support and encouragement to continue
intervening as patients returned for annual reviews.
" CONTROL: --
Multifaceted intervention? " YES
Outcomes " Biological outcomes: percentage of patients that received adequate control=
targets for blood pressure and lipid management
## Psycho-social outcomes
" Process outcomes: cholesterol control, blood pressure control
## Economic outcomes
## Other:
## Positive on:
## Negative on:
" No effect on: no improvement in the number of patients achieving target after
1 year; same for hyperlipidemia and hypertension.
Conclusion: specialist nurses to perform educational outreach does not improve target
adherence to patients with diabetes care.
170 Academic Detailing – Supplement KCE reports 125
Study number 53. Study included
NEWTON-SYMS, 1992
Newton-Syms FA, Dawson PH, Cooke J, Feely M, Booth TG, Jerwood D, et al. The influence of an academic representative on prescribing by general practitioners. Br J Clin Pharmacol. 1992;33(1):69-73.
Quality appraisal score " 13/14
Country " Europe: UK, Leeds
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives " To analyse the effect of providing information about NSAI medicines by a short
sales interview provided by an academic representative on prescribing
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients who need NSAI medications
Caregiver targeted " Family physician (= general practitioner): 101
## Specialist
## Type of physician not specified
Behavior targeted " Rational and economic prescribing of NSAIs to reduce costs
Who does academic detailing ## Nurse
KCE Reports 125 Academic Detailing – Supplement 171
## Physician
" Pharmacist
## Other
Interventions " INTERVENTION: AD-one visit (educational messages) + educational materials
+ educational materials for patients (posters)
## CONTROL:
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
## Process outcomes
" Economic outcomes: prescribing costs
## Other:
" Positive on: there was a decrease in the average prescribing cost per month in
the intervention group compared with the reference group.
## Negative on:
## No effect on:
Conclusion: AD positively affects cost-effective prescribing.
172 Academic Detailing – Supplement KCE reports 125
Study number 54. Study included
NILSSON, 2001
Nilsson G, Hjemdahl P, Hassler A, Vitols S, Wallen NH, Krakau I. Feedback on prescribing rate combined with problem-oriented pharmacotherapy education as a model to improve prescribing behaviour among general practitioners. Eur J Clin Pharmacol. 2001;56(11):843-8.
Quality appraisal score ##
Country " Europe: Sweden (Stockholm)
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To evaluate the effectiveness of a problem-oriented pharmacotherapy education model on prescribing rates of medications for hypertension, peptic ulcer/dyspepsia and depression.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with hypertension, peptic ulcer/dyspepsia and depression
Caregiver targeted " Family physician (= general practitioner)
## Specialist
## Type of physician not specified
Behavior targeted " Prescribing rates of medications for hypertension, peptic ulcer/dyspepsia and
depression.
KCE Reports 125 Academic Detailing – Supplement 173
Who does academic detailing ## Nurse
" Physician
" Pharmacist
## Other
Interventions " INTERVENTION: AD operationalized as a pharmacotherapy education group
consisting of four teacher-physicians, hospitals specialists and clinical pharmacists.
The group provided medical education + educational materials on hypertension,
peptic ulcer/dyspepsia and depression. Three visits were organized + feedback
" CONTROL: intervention groups acted as each others control
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: prescribing rates and DDDs per prescription in the year
before and after the intervention
## Economic outcomes
## Other:
" Positive on: significant effect on prescriptions for agents acting on the renin-
angiotensin system.
## Negative on:
" No effect on: prescribing rates of proton-pump inhibitors and medications for
depression.
Conclusion: Mixed results for a model taregtting prescription behaviour of GPs.
174 Academic Detailing – Supplement KCE reports 125
Study number 55. Study included
OFMAN, 2003
Ofman JJ, Segal R, Russell WL, Cook DJ, Sandhu M, Maue SK, et al. A randomized trial of an acid-peptic disease management program in a managed care environment. Am J Manag Care. 2003;9(6):425-33.
Quality appraisal score " 14/14
Country ## Europe
" US (Orlando)
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT (cluster randomized clinical trial)
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To evaluate the effectiveness of a disease management program on processes of care for patients with acid-related disorders.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with new dyspepsia and chronic users of antisecretory drugs.
Caregiver targeted " Family physician (= general practitioner): 35 physicians (200 patients) in
intervention; 48 control (206 patients)
## Specialist
## Type of physician not specified
Behavior targeted " Processes of care for patients with acid-related disorders.
KCE Reports 125 Academic Detailing – Supplement 175
Who does academic detailing ## Nurse
## Physician
" Pharmacist
## Other
Interventions " INTERVENTION: guidelines + single group meeting with alocal physician
champion + AD + 3 follow-up group meetings + nursing & pharmacist education +
on-site H pylori serology testing + education of patients on h pylori and the
management of side effects + follow up by phone of patients by nurse.
" CONTROL: usual care
Multifaceted intervention? " YES
Outcomes " Biological outcomes: symptoms (epigastric pain, heartburn,..)
" Psycho-social outcomes: satisfaction with care, health-related quality of life
" Process outcomes: H.pylori testing
## Economic outcomes
## Other:
" Positive on: improvements in helicobacter pylori testing, use of recommended
helicobacter pylori treatment regimens, and discontinuation rates of proton pump
therapy after treatment. Few differences in patient quality of life and symptoms.
## Negative on:
" No effect on: Few differences in patient quality of life and symptoms.
Conclusion: The disease management program for patients with acid-related disorders led to
improvements in processes of care.
176 Academic Detailing – Supplement KCE reports 125
Study number 56. Study included
ORNSTEIN, 2004 Ornstein S, Jenkins RG, Nietert PJ, Feifer C, Roylance LF, Nemeth L, et al. A
multimethod quality improvement intervention to improve preventive cardiovascular care: a cluster randomized trial. Ann Intern Med. 2004;141(7):523-32.
Quality appraisal score " 13/14
Country ## Europe
" US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives " To determine whether a multimethod quality improvement program was
more effective than a less intensive intervention for improving adherence to 21 quality indicators for primary and secondary prevention of cardiovascular disease and stroke.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with (risk for) cardiovascular disease and (risk for )stroke
Caregiver targeted " Family physician (= general practitioner): 20 community based practices or
general internal medicine practices in 14 states.
## Specialist
## Type of physician not specified
Behavior targeted " Prevention of cardiovascular disease and stroke.
KCE Reports 125 Academic Detailing – Supplement 177
Who does academic detailing ## Nurse
" Physician
" Pharmacist
" Other: persons with experience in quality improvement
Interventions " INTERVENTION: guidelines + quarterly performance reports (= feedback)
documenting the practice’s adherence to each of the 21 study indicators + practice
site visits (6-7 visits with an elapse time of one or two days every three months) +
network meetings + instructions for the use of quality improvement tools available
in the electronic medical record
" CONTROL: performance reports
Multifaceted intervention? " YES
Outcomes " Biological outcomes: 7 outcome measures which reflected whether patients
achieved recommended treatment goals.
## Psycho-social outcomes
" Process outcomes: 14 process measures reflecting if recommended tests were
done, appropriate diagnoses made or appropriate medication prescribed.
Percentage of performance targets achieved.
## Economic outcomes
## Other:
" Positive on: positive trends for the percentage of quality indicators at or above
target, but no differences between intervention and control. Positive results for
diagnoses of hypertension and blood pressure control in patients with hypertension.
## Negative on:
" No effect on: no differences between intervention and control.
Conclusion: Mixed results of DM-program on prevention of cardiovascular disease and stroke. A multi-method QI improvement program is only marginally more effective than performance reports alone for improving adherence to 21 quality indicators for primary and secondary prevention of cardiovascular disease and stroke in primary care practices.
178 Academic Detailing – Supplement KCE reports 125
Study number 57. Study included
PATON, 2008 Paton C. The use of academic detailing to improve evidence based prescribing of risperidone long acting injection. Int. J. Psychiatry Clin. Pract. 2008, 12 (3): 210-214.
Quality appraisal score " 9/14
Country " Europe: UK
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " Time series
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives " To evaluate the effectiveness of AD on Rational Prescribing of risperidone
long-acting injection (RLAI)
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with schizophrenia
Caregiver targeted ## Family physician
" Specialist: psychiatrists
## Type of physician not specified
Behavior targeted " Rational Prescribing of risperidone long-acting injection (RLAI)
Who does academic detailing ## Nurse
## Physician
KCE Reports 125 Academic Detailing – Supplement 179
## Pharmacist
" Other: trained detailer, not specified
Interventions " INTERVENTION: Ad visits + guidelines (summaries)
Multifaceted intervention? " NO
Outcomes Biological outcomes:
Psycho-social outcomes
" Process outcomes: prescribing of risperidone long-acting injection (RLAI)
Economic outcomes
" Other: Prescribers ‘ knowledge of the evidence base and why RLAI is used
" Positive on: AD was effective in changing prescribing practice (Rational Prescribing of risperidone long-acting injection (RLAI)
Negative on:
No effect on:
Conclusion: AD was effective in changing prescribing practice + improving knowledge on rational Prescribing of risperidone long-acting injection (RLAI)
180 Academic Detailing – Supplement KCE reports 125
Study number 58. Study included
PETERSON, 1996
Peterson GM, Bergin JK, Nelson BJ, Stanton LA. Improving drug use in rheumatic disorders. J Clin Pharm Ther. 1996;21(4):215-20.
Quality appraisal score ##
Country ## Europe
## US
## Canada
" Australia (Southern Tasmania)
## Asia (specify)
Initiator " Not specified
Design ## RCT
" Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives " To evaluate if academic detailing (AD) was effective on rational prescribing of
NSAIDs
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with rheumatic disorders
Caregiver targeted " Family physician (= general practitioner): 177
## Specialist
## Type of physician not specified
Behavior targeted " Rational prescribing of NSAIDs
Who does academic detailing ## Nurse
KCE Reports 125 Academic Detailing – Supplement 181
## Physician
" Pharmacist
## Other
Interventions " INTERVENTION: AD—20 session (interactive discussion + educational
materials)
## CONTROL:
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: (DDD) Daily Dosed Dispensed for NSAID compared to
paracetamol
" Economic outcomes: hospital admissions due to gastric ulcers
## Other:
" Positive on: Changes in prescribing of NSAIDs were evident in both study
regions, but were significantly greater in the intervention area compared to the
control area. A decline in public hospital admissions was noted too.
## Negative on:
## No effect on:
Conclusion: This study shows that an educational programme utilizing AD by pharmacists can
modify prescribing practices within the community. AD session well received by GPs.
182 Academic Detailing – Supplement KCE reports 125
Study number 59. Study included
PETERSON, 1997
Peterson GM, Stanton LA, Bergin JK, Chapman GA. Improving the prescribing of antibiotics for urinary tract infection. J Clin Pharm Ther. 1997;22(2):147-53.
Quality appraisal score " 10/14
Country ## Europe
## US
## Canada
" Australia (South Tasmania)
## Asia (specify)
Initiator " Not specified
Design ## RCT
" Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives " To examine whether AD performed by a pharmacist could modify prescribing
for antibiotics used in the treatment of Urinary Tract Infections (UTI) in the community setting.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with urinary tract infections
Caregiver targeted " Family physician (= general practitioner): 169
## Specialist
## Type of physician not specified
Behavior targeted " Prescribing for antibiotics used in the treatment of Urinary Tract Infections
(UTI) in the community setting.
Who does academic detailing ## Nurse
KCE Reports 125 Academic Detailing – Supplement 183
## Physician
" Pharmacist
## Other
Interventions " INTERVENTION: AD—20 session (interactive discussion + educational
materials)
## CONTROL:
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: the total DDDs dispensed for the recommended first-line
agents (amoxicillin-potassium clavulanate, cephalexin and trimethoprim)
## Economic outcomes
## Other:
" Positive on: total DDDs in intervention group
## Negative on:
## No effect on:
Conclusion: This study shows that an educational programme utilizing AD by pharmacists can
modify prescribing practices for antibiotics within the community. AD session well received by
GPs.
184 Academic Detailing – Supplement KCE reports 125
Study number 60. Study included
PIT, 2007
Pit SW, Byles JE, Henry DA, Holt L, Hansen V, Bowman DA. A Quality Use of Medicines program for general practitioners and older people: a cluster randomised controlled trial. Med J Aust. 2007;187(1):23-30.
Quality appraisal score " 14/14
Country ## Europe
## US
## Canada
" Australia
## Asia (specify)
Initiator " Not specified
Design " RCT (cluster randomized trial)
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives " To investigate the effectiveness of an educational Quality Use of Medicines
program, delivered at the level of general practice, on medicines use, falls and quality of life in people > 65 years.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Elderly people taking benzodiazepines, NSAIDs/COX-2 inhibitors and
antihypertensives.
Caregiver targeted " Family physician (= general practitioner)
## Specialist
## Type of physician not specified
Behavior targeted " Rational prescribing
KCE Reports 125 Academic Detailing – Supplement 185
Who does academic detailing ## Nurse
## Physician
" Pharmacist
## Other
Interventions " INTERVENTION: AD + provision of prescribing information and feedback +
medication risk assessment + facilitation of medication review + financial incentives.
" CONTROL: clinical audit (feedback)
Multifaceted intervention? " YES
Outcomes " Biological outcomes: occurrence of falls
" Psycho-social outcomes: quality of life assessed by SF-12 and EQ-5D Scores.
" Process outcomes: Use of benzodiazepines, NSAIDs and thiazide diuretics
## Economic outcomes
" Other: use of medication reviews
" Positive on: in intervention group; improved medication use composite score
at 4-month follow-up (but not after 12 months), reduction in use of NSAIDs,
benzodiazepines (not significant) and thiazide diuretics, lower number of falls and
injury requiring medical attention.
## Negative on:
" No effect on: Quality of life scores
Conclusion: Education and systems for medication review conducted by GPs can be used to
improve use of medicines. These interventions are associated with a reduction in falls among
older people, without adverse effects on quality of life.
186 Academic Detailing – Supplement KCE reports 125
Study number 61. Study included
RAISCH, 1990
Raisch DW, Bootman JL, Larson LN, McGhan WF. Improving antiulcer agent prescribing in a health maintenance organization. Am J Hosp Pharm. 1990;47(8):1766-73.
Quality appraisal score " 13/14
Country ## Europe
" US (Arizona)
## Canada
## Australia:
## Asia (specify)
Initiator " HMO
Design ## RCT
" Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To evaluate the effect of one-to-one educational meetings between physicians and pharmacists on the prescribing of anti-ulcer agents for outpatients.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients needing anti-ulcer agents
Caregiver targeted " Family physician (= general practitioner): intervention (16), control (8).
## Specialist
## Type of physician not specified
Behavior targeted " Prescribing of antiulcer agents.
Who does academic detailing ## Nurse
KCE Reports 125 Academic Detailing – Supplement 187
## Physician
" Pharmacist
## Other
Interventions " INTERVENTION: AD (10 minutes presentations) using case studies (= ‘vivid
interventions’)
" CONTROL: statistical data (=‘nonvivid interventions’)
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: prescribing of anti-ulcer agents (cimetidine, ranitidine and
sucralfate)
" Economic outcomes: cost per precription
## Other:
" Positive on: no differences in appropriateness were found between the two
intervention groups, but in the first postintervention month the mean rate of
inappropriate prescribing per control practitioner was 80% versus > 32% for the
intervention groups. Positive effect on mean cost per control practitioner and per
patient due to appropriate prescribing.
## Negative on:
" No effect on:
Conclusion: One-to-one educational meetings between physicians and a pharmacist improved
the prescribing of anti-ulcer agents for outpatients.
188 Academic Detailing – Supplement KCE reports 125
Study number 62. Study included
RAY, 1985
Ray WA, Schaffner W, Federspiel CF. Persistence of improvement in antibiotic prescribing in office practice. JAMA. 1985;253(12):1774-6.
Quality appraisal score " 13/14
Country ## Europe
" US (Tennessee)
## Canada
## Australia:
## Asia (specify)
Initiator " Tennessee Medical Association
Design ## RCT
## Controlled study (prospective/retrospective):
## Before-after:
" Time series
Objectives
" To evaluate whether the improvement in antibiotic prescribing produced by the physician-counselor vists persisted for a second year, and if the improvement persisted, whether the effect was attenuated and what the estimated reducation was in expenditures produced by the educational program.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients needing antibiotics
Caregiver targeted " Family physician (= general practitioner): 332
## Specialist
## Type of physician not specified
Behavior targeted " Prescription of contra-indicated antibiotics and cephalosporins.
KCE Reports 125 Academic Detailing – Supplement 189
Who does academic detailing ## Nurse
" Physician
" Pharmacist
## Other
Interventions " INTERVENTION: AD by physician/pharmacist, but in separate regions of the
state (interactive discussion—poor explanation in article)
" CONTROL: usual care
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: average change index of contra-indicated antibiotics
(chloramphenicol, clindamycin, tetracycline for children younger than 8 years) and
cephalosporins.
## Economic outcomes
## Other:
" Positive on: the beneficial effect of the physician-counselors persisted
throughout year 2 with reductions in prescribing for both classes of drugs and cost
savings.
## Negative on:
" No effect on: reductions in prescribing in the group of pharmacist-counselors
Conclusion: the beneficial effect of the physician-counselors is demonstrated through this
project.
190 Academic Detailing – Supplement KCE reports 125
Study number 63. Study included
RAY, 1986
Ray WA, Blazer DG, 2nd, Schaffner W, Federspiel CF, Fink R. Reducing long-term diazepam prescribing in office practice. A controlled trial of educational visits. JAMA. 1986;256(18):2536-9.
Quality appraisal score " 9/14
Country ## Europe
" US
## Canada
## Australia:
## Asia (specify)
Initiator " Tennessee Medical Association
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" This study tested the efficacy of positive, educational methods in the reduction of diazepam prescribing in office practice
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients needing benzodiazepine anxiolytic drug
Caregiver targeted " Family physician (= general practitioner): 44
## Specialist
## Type of physician not specified
Behavior targeted " Reduction of diazepam prescribing in office practice
KCE Reports 125 Academic Detailing – Supplement 191
Who does academic detailing ## Nurse
" Physician
## Pharmacist
## Other
Interventions " INTERVENTION: AD + educational materials
" CONTROL: usual care
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: prescribing of diazepam
## Economic outcomes
" Other: Receptivity of doctors to educational program
" Positive on: Lower prescribing of diazepam in intervention group and positive
receptivity of doctors to educational program
## Negative on:
## No effect on:
Conclusion:
192 Academic Detailing – Supplement KCE reports 125
Study number 64. Study included
RICORDEAU, 2003
Ricordeau P, Durieux P, Weill A, Chatellier G, Vallier N, Bissery A, et al. Effect of a nationwide program of educational outreach visits to improve the processes of care for patients with type 2 diabetes. International Journal of Technology Assessment in Health Care. 2003;19(4):705-10.
Quality appraisal score " 9/14
Country " Europe: France
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design ## RCT
## Controlled study (prospective/retrospective):
## Before-after:
" Time series:
Objectives " To evaluate the effectiveness of physician to physician AD on the management
of type 2 diabetes
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with diabetes
Caregiver targeted " Family physician (= general practitioner)—22.940
" Specialist: endocrinologists
## Type of physician not specified
Behavior targeted " Management of type 2 diabetes
Who does academic detailing ## Nurse
KCE Reports 125 Academic Detailing – Supplement 193
" Physician
## Pharmacist
## Other
Interventions " INTERVENTION: AD (outreach or phone consultation) + guidelines
## CONTROL: ---
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: monthly proportion of the number of HbA1c
measurements to the total of laboratory tests
## Economic outcomes
## Other:
" Positive on: the number of HbA1c tests (increase) and blood glucose
measurements and urine microalbumin
## Negative on:
## No effect on:
" Conclusion: Physician to physician outreach visits can be effective to improve processes
of care for diabetes and to routinize nationwide use of practice guidelines.
194 Academic Detailing – Supplement KCE reports 125
Study number 65. Study included
SCHUSTER, 2008
Schuster RJ, Tasosa J, Terwoord NA. Translational research - Implementation of NHLBI obesity guidelines in a primary care community setting: The physician obesity awareness project. Journal of Nutrition, Health and Aging. 2008;12(10 SUPPL.):764S-9S.
Quality appraisal score " 11/14
Country ## Europe
" US: Dayton, Ohio
## Canada
## Australia
## Asia (specify)
Initiator " Not specified
Design ## RCT
" Controlled study (prospective/retrospective):
## Before-after:
## Time series
Objectives
" To increase involvement in translating proven research into practice to improve physician awareness and improve outcomes of overweight/obesity
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with obesity
Caregiver targeted " Family physician (= general practitioner): 21
## Specialist
## Type of physician not specified
Behavior targeted " Management of obesity
Who does academic detailing ## Nurse
KCE Reports 125 Academic Detailing – Supplement 195
## Physician
## Pharmacist
## Other
" Not specified
Interventions " INTERVENTION: physician obesity education through AD
" (enhanced intervention): physician obesity education
Multifaceted intervention? " YES
Outcomes " Biological outcomes: cardiovascular disease risk factors: lipid levels, blood
pressure and blood glucose
## Psycho-social outcomes
" Process outcomes: documentation of physician obesity management: BMI,
weight, record height to allow BMI calculation
## Economic outcomes
" Other: Physician knowledge of obesity as a CVD factor
" Positive on: the number of physicians that discussed obesity with their patients,
reference to obesity management increased, BMI and cardio-vascular co-
morbidities improved.
## Negative on:
## No effect on:
Conclusion: A combination of AD and presentation of outcomes to physicians improves
awareness and result in improved outcomes.
196 Academic Detailing – Supplement KCE reports 125
Study number 66. Study included
SCHAFFNER, 1983
Schaffner W, Ray WA, Federspiel CF, Miller WO. Improving antibiotic prescribing in office practice. A controlled trial of three educational methods. JAMA. 1983;250(13):1728-32.
Quality appraisal score " 13/14
Country ## Europe
" US
## Canada
## Australia:
## Asia (specify)
Initiator " A consortium of State’s medical societies
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To improve antibiotic prescribing in office practice
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Children needing antibiotics
Caregiver targeted " Family physician (= general practitioner): 372 (1087 patients)
## Specialist
## Type of physician not specified
Behavior targeted " Elimination of prescription of contraindicated antibiotics for use in office
practice: chloramphenicol, clindamycin and tetracycline for children younger than 8
years) and reduction of oral cephalosporins.
KCE Reports 125 Academic Detailing – Supplement 197
Who does academic detailing ## Nurse
" Physician
" Pharmacist
## Other
Interventions " INTERVENTION: AD (15 minutes) + educational materials
" CONTROL: usual care
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: Prescription of contraindicated antibiotics for use in office
practice: chloramphenicol, clindamycin and tetracycline for children younger than 8
years and oral cephalosporins.
## Economic outcomes
## Other:
" Positive on: when physician educators were used, strong attributable
reductions in prescribing of both drug classes were obtained. The drug educator
had only a modest effect.
## Negative on:
" No effect on: The mailed brochure had no detectable effect.
Conclusion: AD by physicians if effective on the prescription of contracindicated antibiotics
and a reduction in the prescribing of cephalosporines.
198 Academic Detailing – Supplement KCE reports 125
Study number 67. Study included
SHANAHAN, 2006
Shanahan M, Shakeshaft A, Mattick RP. Modelling the costs and outcomes of changing rates of screening for alcohol misuse by GPs in the Australian context. Applied Health Economics and Health Policy. 2006;5(3):155-66.
Quality appraisal score " 10/14
Country ## Europe
## US
## Canada
" Australia
## Asia (specify)
Initiator " Not specified
Design ## RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
" A modelling approach
Objectives
" To assess the relative cost effectiveness of four strategies (academic detailing, computerised reminder systems, target payments and interactive continuing medical education) of screening for alcohol misuse.
Setting ## Physician’s office
## Primary care clinic
## Other (specify):
" Not specified
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
## Elderly
" Alcohol abuse
Caregiver targeted " Family physician (= general practitioner)
## Specialist
## Type of physician not specified
KCE Reports 125 Academic Detailing – Supplement 199
Behavior targeted " Screening of alcohol abuse
Who does academic detailing ## Nurse
## Physician
## Pharmacist
## Other
" Not specified
Interventions ## INTERVENTION: NA
## CONTROL: NA
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: screening for alcohol abuse in adults
## Economic outcomes
## Other:
" Positive on: achieving a decrease in the number of standards drinks consumed
by risky drinkers.
## Negative on:
## No effect on:
Conclusion: Targeted payments are the least efficient of four commonly used strategies to
increase GPs provision of care to reduce alcohol consumption among their patients. Academic
detailing and computerised reminder system appear most effective in achieving a decrease in the
number of standards drinks consumed by risky drinkers.
200 Academic Detailing – Supplement KCE reports 125
Study number 68. Study included
SIEGEL, 2003
Siegel D, Lopez J, Meier J, Goldstein MK, Lee S, Brazill BJ, et al. Academic detailing to improve antihypertensive prescribing patterns. American Journal of Hypertension. 2003;16(6):508-11.
Quality appraisal score " 10/14
Country ## Europe
" US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design ## RCT
## Controlled study (prospective/retrospective):
" Before-after
## Time series:
Objectives " To increase practitioners compliance with antihypertensive treatment
guidelines
Setting " Physician’s office (community outpatient centers and academic medical clinics)
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with hypertension, diabetes mellitus and heart failure
Caregiver targeted " Family physician (= general practitioner): 308 patients
## Specialist
## Type of physician not specified
Behavior targeted " Compliance with antihypertensive treatment guidelines
Who does academic detailing ## Nurse
KCE Reports 125 Academic Detailing – Supplement 201
## Physician
## Pharmacist
## Other
" Not specified
Interventions " INTERVENTION: face-to face (10-15 minutes) and group AD + 4 hour training
sessions (effective communication techniques, discussion on normal
antihypertensive recommendations, use of computer programs to extract and
format data) + teleconference + educational materials + feedback (provider
profiling of prescribing patterns)
## CONTROL:
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: prescription of thiazide diuretics, beta-blockers and calcium
antagonists, angiotensine converting enzyme inhibitor, angiotensine receptor
blocker
## Economic outcomes
## Other:
" Positive on: prescribing of number of calcium antagonists, beta-blockers,
thiazide diuretics for patients with hypertension. For hypertensive subjects with
diabetes mellitus or congestive heart failure, the proportion receiving an
angiotensine converting enzyme inhibitor or angiotensin receptor blocker
increased. Among hypertensive subjects with coronary artery disease and increase
in beta-blocker use was noted.
## Negative on:
## No effect on:
Conclusion: Multifaceted intervention including AD effective on prescribing patterns compliant
to national guidelines
202 Academic Detailing – Supplement KCE reports 125
Study number 69. Study included
SIMON, 2005
Simon SR, Majumdar SR, Prosser LA, Salem-Schatz S, Warner C, Kleinman K, et al. Group versus individual academic detailing to improve the use of antihypertensive medications in primary care: a cluster-randomized controlled trial. Am J Med. 2005;118(5):521-8.
Quality appraisal score " 14/14
Country ## Europe
" US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT (cluster randomized controlled trial)
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives " To compare group versus individual academic detailing to increase diuretic of
beta-blocker use in hypertension.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with newly diagnosed hypertension
Caregiver targeted " Family physician (= general practitioner): 9 practices randomized to 3
intervention arms (physicians: 75; patients: 1066 individual AD; physicians: 87;
patients: 1007 group AD; 1619 in mail intervention sites)
## Specialist
## Type of physician not specified
Behavior targeted " Diuretic of beta-blocker use in hypertension
KCE Reports 125 Academic Detailing – Supplement 203
Who does academic detailing ## Nurse
## Physician
## Pharmacist
## Other
" Not specified ‘trained detailer’
Interventions " INTERVENTION: individual AD (15-30 minutes)
" INTERVENTION: group AD (45 small group session: 7-8 physicians
attendance)
" CONTROL: mail intervention
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: rates of diuretic or beta-blocker use
## Economic outcomes: intervention costs and medication costs
## Other:
" Positive on: rates of diuretic or beta-blocker use increased in both individual
and group AD practices
## Negative on:
" No effect on: neither intervention affected blood pressure control
Conclusion: both individual and group AD imrpved antihypertensive prescribing above and
over usual care. Individual AD had a more persistent effect two years after intervention
204 Academic Detailing – Supplement KCE reports 125
Study number 70. Study included
SIMON, 2007
Simon SR, Rodriguez HP, Majumdar SR, Kleinman K, Warner C, Salem-Schatz S, et al. Economic analysis of a randomized trial of academic detailing interventions to improve use of antihypertensive medications. J Clin Hypertens (Greenwich). 2007;9(1):15-20.
Quality appraisal score " 14/14
Country ## Europe
" US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " Retrospective cost-analysis of a RCT (cluster randomized controlled trial)
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives " Estimating the costs and cost savings (perspective of the payer) of
implementing a program of mailed practice guidelines, single-visits individual and group academic detailing in a RCT to improve the use of antihypertensive medications.
Setting " Physician’s office (NA)
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with hypertension
Caregiver targeted " Family physician (= general practitioner): 9 practices randomized to 3
intervention arms (patients: 1066 individual AD; 1007 group AD; 1619 in mail
intervention sites)
## Specialist
## Type of physician not specified
Behavior targeted " Diuretic of beta-blocker use in hypertension
KCE Reports 125 Academic Detailing – Supplement 205
Who does academic detailing ## Nurse
## Physician
## Pharmacist
## Other
" Not specified ‘trained detailer’
Interventions " INTERVENTION: individual AD (15-30 minutes)
" INTERVENTION: group AD (45 small group session: 7-8 physicians
attendance)
" CONTROL: mail intervention
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
## Process outcomes:
" Economic outcomes: average daily drug cost
## Other:
" Positive on: the individual AD resulted in an estimated net decrease in average
daily drug cost per person beyond the reductions in the mail group, although this
finding did not reach statistical significance. The estimated net reduction
corresponded to savings.
## Negative on:
" No effect on: The group AD resulted in no change in the average daily cost of
antihypertensive agents.
Conclusion: Mixed results on cost-savings, but individual AD demonstrated better cost savings
compared to group and mailing intervention
206 Academic Detailing – Supplement KCE reports 125
Study number 71. Study included
SIRIWARDENA, 2002
Siriwardena AN, Rashid A, Johnson MR, Dewey ME. Cluster randomised controlled trial of an educational outreach visit to improve influenza and pneumococcal immunisation rates in primary care. Br J Gen Pract. 2002;52(482):735-40.
Quality appraisal score " 12/14
Country " Europe: UK (Trent region)
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT (cluster randomized controlled trial)
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives " To improve the delivery of influenza and pneumoccocal vaccinations to high-
risk groups.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" High risk patients (age > 65 years, coronary heart disease, diabetes and a
history of splenectomy) needing influenza and pneumoccocal vaccinations.
Caregiver targeted " Family physician (= general practitioner): 30 (15 intervention; 15 control)
## Specialist
## Type of physician not specified
Behavior targeted " Influenza and pneumoccocal vaccinations
KCE Reports 125 Academic Detailing – Supplement 207
Who does academic detailing ## Nurse
" Physician (general practitioner)
## Pharmacist
## Other
Interventions " INTERVENTION: AD (+/- one hour; often during primary health care team
meeting, exploring barriers to vaccination + information) + audit + feedback of
practice vaccination rates
" CONTROL: written feed-back on vaccination rates
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: rates of influenza and pneumoccocal vaccination for
patients age > 65 years, coronary heart disease, diabetes and a history of
splenectomy
## Economic outcomes
## Other:
" Positive on: Improvements in pneumoccocal vaccination rates in the
intervention practices were significantly greater compared to controls in patients
with CHD and diabetes but not splenectomy. Improvements for influenza
vaccination were also greater in intervention practices but did not reach statistical
significance.
## Negative on:
## No effect on:
Conclusion: AD is effective on the uptake pneumococcal vaccination in high risk groups, but
not for influenza vaccination.
208 Academic Detailing – Supplement KCE reports 125
Study number 72. Study included
SHEINFELD, 2000
Sheinfeld Gorin S, Gemson D, Ashford A, Bloch S, Lantigua R, Ahsan H, et al. Cancer education among primary care physicians in an underserved community. Am J Prev Med. 2000;19(1):53-8.
Quality appraisal score " 10/14
Country ## Europe
" US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design ## RCT
## Controlled study (prospective/retrospective):
" Before-after design
## Time series:
Objectives
" To evaluate the effectiveness of a QI program on cancer screening and prevention in an underserved community
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted " Cancer (colon, rectum, cervix, prostate, breast and lung)
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
Caregiver targeted " Family physician (= general practitioner): 84 intervention; 38 control.
## Specialist
## Type of physician not specified
Behavior targeted " Cancer prevention and screening practices
Who does academic detailing ## Nurse
## Physician
## Pharmacist
KCE Reports 125 Academic Detailing – Supplement 209
## Other
" Not specified (bachelors, masters and public health professionals)
Interventions " INTERVENTION: AD (+/- 2-3 visits; practice visits and contacts over the
phone, information) + educational materials + perceived barriers to
implementation + educational materials for patients + dinner seminars about
cancer prevention and screening
## CONTROL:
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: self-reported cancer prevention and screening practices
## Economic outcomes
" Other: knowledge of ACS screening guidelines for the colon, rectum, cervix,
prostate, breast and lung
" Positive on: Identified barriers to practice
## Negative on:
" No effect on: no significant differences in knowledge of cancer prevention or
screening.
Conclusion: Educational visits did not seem to alter cancer screening and prevention practices.
210 Academic Detailing – Supplement KCE reports 125
Study number 73. Study included
STONE, 2005
Stone CA, May FW, Pinnock CB, Elwood M, Rowett DS. Prostate cancer, the PSA test and academic detailing in Australian general practice: an economic evaluation. Aust N Z J Public Health. 2005;29(4):349-57.
Quality appraisal score " NA
Country ## Europe
## US
## Canada
" Australia
## Asia (specify)
Initiator " Not specified
Design ## RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
" Modelling scenario
Objectives
" To evaluate whether introduction of a national education program for GPS to improve decision making relating to the use of prostate specific antigen (PSA) testing for screening represents value-for-money from the perspective of the Australian government.
Setting ## Physician’s office
## Primary care clinic
## Other (specify):
" NA
Population targeted " Cancer (prostate cancer)
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
Caregiver targeted " Family physician (= general practitioner)
## Specialist
## Type of physician not specified
KCE Reports 125 Academic Detailing – Supplement 211
Behavior targeted " PSA screening
Who does academic detailing ## Nurse
## Physician
" Pharmacist
## Other
Interventions ## INTERVENTION:
## CONTROL:
" NA
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
## Process outcomes
" Economic outcomes
## Other:
" Positive on: A national program would reduce the burden of disease by 4.7% of
total DALYs due to prostate cancer in those aged 70 and over, with no loss of life
and an incremental cost effectiveness ratio of 16.000/DALY (gross) and 8.500/DALY
(net).
## Negative on:
## No effect on:
Conclusion:
212 Academic Detailing – Supplement KCE reports 125
Study number 74. Study included
TENG, 2006
Teng CL, Achike FI, Phua KL, Nurjahan MI, Mastura I, Asiah HN, et al. Modifying antibiotic prescribing: the effectiveness of academic detailing plus information leaflet in a Malaysian primary care setting.[see comment]. Med J Malaysia. 2006;61(3):323-31.
Quality appraisal score " 8/14
Country ## Europe
## US
## Canada
## Australia:
" Asia (specify): Malaysia
Initiator " Not specified
Design ## RCT
## Controlled study (prospective/retrospective):
## Before-after:
" Time series: Interrupted time series design
Objectives
" To evaluate the effectiveness of AD on prescribing of antibiotics for URTI
Setting ## Physician’s office
" Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
" Respiratory diseases (Upper respiratory Tract Infections)
Caregiver targeted " Family physician (= general practitioner): 29
## Specialist
## Type of physician not specified
Behavior targeted " Prescription of antibiotics
Who does academic detailing ## Nurse
" Physician (family care specialist)
KCE Reports 125 Academic Detailing – Supplement 213
## Pharmacist
## Other
Interventions " INTERVENTION: AD (20 minute one-to-one meeting + guidelines
(summarized on one page leaflet) + poster (leaflet)
## CONTROL:
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: prescription of antibiotics
## Economic outcomes
## Other:
" Positive on: reductions in the prescription of antibiotics for URTI
## Negative on:
## No effect on:
Conclusion: AD is effective on a reduction in the prescription of antibiotics for URTI .
214 Academic Detailing – Supplement KCE reports 125
Study number 75. Study included
TURNER, 2000
Turner CJ, Parfrey P, Ryan K, Miller R, Brown A. Community pharmacist outreach program directed at physicians treating congestive heart failure. American Journal of Health-System Pharmacy. 2000;57(8):747-52.
Quality appraisal score " 9/14
Country ## Europe
" US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To evaluate the ability of a pharmacist outreach program to address underutilization of ACE inhibitors among patients receiving treatment for CHF (congestive heart failure)
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
" Heart failure (congestive heart failure)
## Neurodegenerative diseases
## Respiratory diseases
Caregiver targeted " Family physician (= general practitioner)
## Specialist
## Type of physician not specified
" Pharmacist
Behavior targeted " Prescription of ACE inhibitors and angiotensin 2 receptor antagonists for the
prevention and management of CHF.
KCE Reports 125 Academic Detailing – Supplement 215
Who does academic detailing ## Nurse
## Physician
" Pharmacist
## Other
Interventions " INTERVENTION: AD + guidelines
" CONTROL: AD
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: self-reported use of prescription of ACE inhibitors and
angiotensin 2 receptor antagonists for the prevention and management of CHF.
## Economic outcomes
## Other:
## Positive on:
## Negative on:
" No effect on: no significant difference in ACE-inhibitor prescribing between
intervention and control group
Conclusion: A pharmacist outreach program involving AD did not affect prescribing or
dosages of ACE inhibitors but demonstrated value as a quality assurance tool.
216 Academic Detailing – Supplement KCE reports 125
Study number 76. Study included
VARONEN, 2007
Varonen H, Rautakorpi U-M, Nyberg S, Honkanen PO, Klaukka T, Palva E, et al. Implementing guidelines on acute maxillary sinusitis in general practice--a randomized controlled trial. Fam Pract. 2007;24(2):201-6.
Quality appraisal score " 13/14
Country " Europe: Finland
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT (multi-centre RCT conducted in 30 health centers).
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To study whether a nationwide guidelines implementation programme has an effect on the management of acute maxillary sinusitis (antibiotics prescribing)
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
" Respiratory diseases: acute maxillary sinusitis
Caregiver targeted " Family physician (= general practitioner)
## Specialist
## Type of physician not specified
Behavior targeted " Management of acute maxillary sinusitis (antibiotics prescribing)
Who does academic detailing ## Nurse
" Physician
KCE Reports 125 Academic Detailing – Supplement 217
## Pharmacist
## Other
## Not specified (‘external experts’)
Interventions " INTERVENTION: AD (information sources, feedback, and visits) by local
general practitioner
" CONTROL: problem-based learning
Multifaceted intervention? " NO
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: prescribing of antibiotics for acute maxillary sinusitis
(Amoxicillin), proportion of courses of antibiotics with recommended duration
## Economic outcomes
## Other:
" Positive on: Use of first line drugs (amoxicillin): increased
## Negative on:
" No effect on: there were no significant changes between AD and problem-
based learning methods.
Conclusion: The program produced modest changes in the management of AMS, but AD was
not more effective compared to other educational techniques.
218 Academic Detailing – Supplement KCE reports 125
Study number 77. Study included
VAN DEN HOMBERG, 1999
Van den Hombergh, P, Grol R, et al. Practice visits as a tool in quality improvement: mutual visits and feedback by peers compared with visits and feedback by non-physician observers. Qual Health Care 8, 1999 (3): 161-6
Quality appraisal score " 14/14
Country " Europe: The Netherlands
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT (prospective, randomised intervention study, with follow-up after one
year).
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To evaluate and compare the effects of two programs of assessment of practice management in a practice visit on functioning of GP practices
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Not applicable
Caregiver targeted " Family physician (= general practitioner): 14 local groups with 109 GPs
## Specialist
## Type of physician not specified
Behavior targeted " Global Practice functioning
KCE Reports 125 Academic Detailing – Supplement 219
Who does academic detailing ## Nurse
" Physician
## Pharmacist
" Other: non-physician observers
Interventions " INTERVENTION: Practice visits by peers (physicians)
" INTERVENTION: Practice visit by non physician observers
Multifaceted intervention " NO
Outcomes ## Biological outcomes
" Psycho-social outcomes: job-stress in physicians
" Process outcomes: delegation and collaboration
## Economic outcomes
" Other: Premises and equipment, service and organization, record keeping,
organisation of quality improvement, workload
" Positive on: both programmes resulted into improvements on many aspects of
practice management. Practice visits by peers resulted into better performance for
equipment, collaboration with colleagues, accessibility of patient information than
after a visit of a non physician observer. Visits by non physician observers resulted
in a higher score on extent of use of records, outcome assessment and year report.
## Negative on:
## No effect on:
Conclusion: AD by either physicians or non-physician observers effective on improvements in
practice management.
220 Academic Detailing – Supplement KCE reports 125
Study number 78. Study included
VAN DER WEIJDEN, 1999
van der Weijden T, Grol RP, Knottnerus JA. Feasibility of a national cholesterol guideline in daily practice. A randomized controlled trial in 20 general practices. Int J Qual Health Care. 1999;11(2):131-7.
Quality appraisal score " 13/14
Country " Europe: The Netherlands
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To evaluate the feasibility and implementation needs of a cholesterol guideline by assessing the effectiveness of simple dissemination as well as extensive implementation of this guideline on actual performance of GPs.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients with abnormal cholesterol levels
Caregiver targeted " physician (= general practitioner): 32 GPs in 20 practices, 3950 patient records
## Specialist
## Type of physician not specified
Behavior targeted " Management of cholesterol
Who does academic detailing ## Nurse
KCE Reports 125 Academic Detailing – Supplement 221
## Physician
## Pharmacist
" Other: scientific collaborator
Interventions " INTERVENTION: extensive implementation of guideline= guideline+
educational materials + 3h educational session by local opinion leader + feedback +
2 outreach visits with face-to-face instruction + barriers to change
" CONTROL: simple implementation of guideline= postal distribution of the
guideline with scientific background materials
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: quality of selective case finding (= targeting cholesterol
testing to patients with at least one of the six risk factors mentioned in the
guideline), and quality of diagnostic procedures (= properly diagnosed
hypercholesterolemia requires that average of 3 measurements to be higher than
6.5 mmol/l)
## Economic outcomes
## Other:
" Positive on: quantity of cholesterol testing
" Negative on: performance of the procedure necessary to diagnose
hypercholesterolemia even deteriorated
" No effect on: quality of selective case finding or quality of diagnostic
procedures
Conclusion: Mixed results from multifaceted intervention on management of cholesterol.
222 Academic Detailing – Supplement KCE reports 125
Study number 79. Study included
VAN EIJK, 2001
van Eijk ME, Avorn J, Porsius AJ, de Boer A. Reducing prescribing of highly anticholinergic antidepressants for elderly people: randomised trial of group versus individual academic detailing. BMJ. 2001;322(7287):654-7.
Quality appraisal score " 13/14
Country " Europe: The Netherlands
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT (with 3 intervention arms)
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To compare the effect of individual educational visits versus group visits using academic detailing to discuss prescribing of highly anticholinergic antidepressants in elderly people.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Elderly patients (> 60) needing anticholinergic antidepressants
Caregiver targeted " Family physician (= general practitioner): 37 practices – 190 GPs
" Pharmacists
## Specialist
## Type of physician not specified
Behavior targeted " Prescribing of highly anticholinergic antidepressants in elderly people.
KCE Reports 125 Academic Detailing – Supplement 223
Who does academic detailing ## Nurse
## Physician
## Pharmacist
" Other: researcher
Interventions " INTERVENTION: individual academic detailing (two 20 minute visits) + educational
materials + feedback on practice performance
" INTERVENTION: group academic detailing (two visits)
" CONTROL: no intervention
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: numbers of elderly people with new prescriptions of highly
anticholinergic antidepressants and less anticholinergic antidepressants
## Economic outcomes
## Other:
" Positive on: in both the intervention arms the use of highly anticholinergic
antidepressants decreased + the use of less anticholinergic antidepressants
increased.
## Negative on:
## No effect on:
Conclusion: Academic detailing has a positive effect on the prescribing of anticholinergic
antidepressants.
224 Academic Detailing – Supplement KCE reports 125
Study number 80. Study included
WALSH, 2005
Walsh JM, Salazar R, Terdiman JP, Gildengorin G, Perez-Stable EJ. Promoting use of colorectal cancer screening tests. Can we change physician behavior? J Gen Intern Med. 2005;20(12):1097-101.
Quality appraisal score " 13/14
Country ## Europe
" US (San Francisco)
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To assess the effect of an intervention targeting physicians and their patients on rates of colorectal cancer screening (CRC).
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted " Cancer: patients at risk for development of colorectal cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
Caregiver targeted " Family physician (= general practitioner) or internal medicine: 94; 9652
patients enrolled for 2 years and 3732 patients were enrolled for 5 years.
## Specialist
## Type of physician not specified
Behavior targeted " Colorectal cancer screening (patients aged 50-79)
Who does academic detailing ## Nurse
KCE Reports 125 Academic Detailing – Supplement 225
" Physician: opinion leaders
## Pharmacist
## Other
Interventions " INTERVENTION: AD + educational sessions + guidelines + identification of
barriers + patient intervention: letter, brochure, and a Fecal Occult Blood test
cards
" CONTROL: ---
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: FOBT in the last 2 years, flexible sigmoidoscopy and
colonoscopy in the previous 5 years, CRC screening.
## Economic outcomes
## Other:
" Positive on: patient rates of screening SIG (flexible sigmoidoscopy)
## Negative on:
" No effect on: rates of CRC screening.
Conclusion: Mixed results from study applying academic detailing.
226 Academic Detailing – Supplement KCE reports 125
Study number 81. Study included
WATSON, 2001
Watson M, Gunnell D, Peters T, Brookes S, Sharp D. Guidelines and educational outreach visits from community pharmacists to improve prescribing in general practice: a randomised controlled trial. J Health Serv Res Policy. 2001;6(4):207-13.
Quality appraisal score " 13/14
Country " Europe: UK (Avorn)
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT (cluster randomized trial)
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To evaluate the effectiveness of guidelines with or without ont-to-one educational oureach visits in improving general practice prescribing for non-steroidal anti-inflammatory drugs (NSAIDs).
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients needing non-steroidal anti-inflammatory drugs (NSAIDs).
Caregiver targeted " Family physician (= general practitioner): 20 practices;
## Specialist
## Type of physician not specified
Behavior targeted " Prescribing for non-steroidal anti-inflammatory drugs (NSAIDs).
KCE Reports 125 Academic Detailing – Supplement 227
Who does academic detailing ## Nurse
## Physician
" Pharmacist (community pharmacists)
## Other
Interventions " INTERVENTION: mailed guidelines + educational outreach visits (two 10-
minutes visits)
" INTERVENTION: mailed guidelines
" CONTROL: not intervention
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: change in the volume prescription (DDD) of ibuprofen,
diclofenac and naproxen (= recommended NSAIDs) as a percentage of total NSAID
prescribing
" Economic outcomes: cost-benefit analysis
## Other:
" Positive on: the proportion of prescribing of the five most frequently used
drugs.
" Negative on: a net increase in costs with both interventions
" No effect on: prescription of ibuprofen, diclofenac and naproxen
Conclusion: no impact on prescribing behaviour was noted
228 Academic Detailing – Supplement KCE reports 125
Study number 82. Study included
WELLER, 2003 Weller D, May F, Rowett D, Esterman A, Pinnock C, Nicholson S, et al.
Promoting better use of the PSA test in general practice: randomized controlled trial of educational strategies based on outreach visits and mailout. Fam Pract. 2003;20(6):655-61.
Quality appraisal score " 13/14
Country ## Europe
## US
## Canada
" Australia (South Adelaide)
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To compare the effectiveness of educational outreach visits and mailout strategies targeting PSA testing.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted " Cancer: prostate cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
Caregiver targeted " Family physician (= general practitioner): 145 (46 AD; 47: mail; 52 control)
## Specialist
## Type of physician not specified
Behavior targeted " Prostate-specific antigen testing (PSA)
Who does academic detailing ## Nurse
## Physician
KCE Reports 125 Academic Detailing – Supplement 229
" Pharmacist (trained in social marketing techniques)
## Other
Interventions " INTERVENTION: AD + educational materials + feedback
" INTERVENTION: educational materials by mail
" CONTROL: no intervention
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: PSA testing rates
## Economic outcomes
" Other: GP knowledge
" Positive on: correct responses to questions about prostate cancer treatment
effectiveness and endorsement of PSA testing for prostate cancer by professional
bodies.
## Negative on:
" No effect on: PSA testing rate lower in AD group compared to mail group and
control group.
Conclusion: Mixed results from intervention targeting PSA screening.
230 Academic Detailing – Supplement KCE reports 125
Study number 83. Study included
WILLIAMS, 1994
Williams PT, Eckert G, Epstein A, Mourad L, Helmick F. In-office cancer-screening education of primary care physicians. Journal of Cancer Education. 1994;9(2):90-5.
Quality appraisal score " 8/14
Country ## Europe
" US (Ohio)
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design ## RCT
## Controlled study (prospective/retrospective):
" Before-after
## Time series:
Objectives " To evaluate the effectiveness of academic detailing on cancer preventive and
screening actions in family physicians + increase knowledge of physicians about and use of educational and patient service resources of local, state and national units of the American Cancer Society (ACS) + evaluating if physicians employ the prevention and screening recommendations of the ACS and whether they have developed ways to deal with barriers to implementation of these recommendations + discover what barriers prevent the performance of cancer prevention and screening activities.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted " Cancer: breast, colon-rectum and prostate cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
Caregiver targeted " Family physician (= general practitioner): 22 physicians + staff members
## Specialist
## Type of physician not specified
Behavior targeted " Screening and preventive actions on breast, colon-rectum and prostate cancer.
KCE Reports 125 Academic Detailing – Supplement 231
Who does academic detailing " Nurse
" Physician
## Pharmacist
## Other
Interventions " INTERVENTION: AD (one/two face-to-face visit) + follow-up phone calls +
educational materials for physicians and patients + guidelines + action list for office
management
## CONTROL:
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: activities in compliance with cancer prevention guidelines
## Economic outcomes
## Other:
" Positive on: compliance rates + increased awareness of resources of ACS and in
prompting physicians to adopt cancer prevention and screening procedures, but
least effective in making office changes.
## Negative on:
## No effect on:
Conclusion: AD effective on cancer screening and prevention action in physicians.
232 Academic Detailing – Supplement KCE reports 125
Study number 84. Study included
WITT, 2004
Witt K, Knudsen E, Ditlevsen S, Hollnagel H. Academic detailing has no effect on prescribing of asthma medication in Danish general practice: a 3-year randomized controlled trial with 12-monthly follow-ups. Fam Pract. 2004;21(3):248-53.
Quality appraisal score " 13/14
Country " Europe: (Denmark)
## US
## Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT (cluster randomized trial)
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives " To examine the effect of academic detailing as a method of implementing a
clinical guideline in general practice and to improve GPs prescribing in accordance with the current best medical evidence and to ensure efficient use of health care sources.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
" Respiratory diseases: asthma (children < 16 years of age)
Caregiver targeted " Family physician (= general practitioner)
## Specialist
## Type of physician not specified
Behavior targeted " Prescription of asthma medication (to change medication in children to more
inhaled steroids and less B2-aginists, and to increase the GPs use of peak-flow
meters and spirometry).
KCE Reports 125 Academic Detailing – Supplement 233
Who does academic detailing ## Nurse
## Physician
## Pharmacist
" Other: researchers
Interventions " INTERVENTION: AD (15-20 minute visit) + guideline + feedback (prescription
profile)
" CONTROL: guideline by post + feedback
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: number of asthma medication prescribed (DDD of steroids
and B2-agonists expressed as sales of asthma medication by pharmacies).
## Economic outcomes
## Other:
## Positive on:
## Negative on:
" No effect on: prescription of asthma medication
Conclusion: No effect of AD on prescribing of asthma medication.
234 Academic Detailing – Supplement KCE reports 125
Study number 85. Study included
WONG, 2004
Wong RY, Lee PE. Teaching physicians geriatric principles: a randomized control trial on academic detailing plus printed materials versus printed materials only. J Gerontol A Biol Sci Med Sci. 2004;59(10):1036-40.
Quality appraisal score " 12/14
Country ## Europe
## US
" Canada
## Australia:
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives " Promotion of geriatric knowledge to physicians
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Elderly
Caregiver targeted " Family physician (= general practitioner): 31 (intervention: 16; intervention 2:
15)
## Specialist
## Type of physician not specified
" Postgraduate trainees + staff physicians
Behavior targeted " Geriatric knowledge on cognitive impairment, competency, urinary
incontinence, malnutrition, and stroke.
KCE Reports 125 Academic Detailing – Supplement 235
Who does academic detailing ## Nurse
## Physician
## Pharmacist
" Other: specialist in geriatric medicine
Interventions " INTERVENTION: AD (15 minute session) + printed educational materials
" CONTROL: printed materials only
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
## Process outcomes
## Economic outcomes
" Other: Knowledge score on geriatric knowledge
" Positive on: improvements in geriatric knowledge scores
## Negative on:
## No effect on:
Conclusion: Intervention effective on geriatric knowledge retention.
236 Academic Detailing – Supplement KCE reports 125
Study number 86. Study included
YOUNG, 2002
Young JM, D'Este C, Ward JE. Improving family physicians' use of evidence-based smoking cessation strategies: a cluster randomization trial. Prev Med. 2002;35(6):572-83.
Quality appraisal score " 13/14
Country ## Europe
## US
## Canada
" Australia
## Asia (specify)
Initiator " Not specified
Design " RCT (cluster randomized trial): 2 X 2 balanced incomplete block design
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives
" To improve family physicians’ use of evidence-based smoking cessation strategies
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients who smoke (age 18-70 years)
Caregiver targeted " Family physician (= general practitioner): 60 from 39 practices
## Specialist
## Type of physician not specified
Behavior targeted " Smoking cassation advice
Who does academic detailing ## Nurse
KCE Reports 125 Academic Detailing – Supplement 237
## Physician
## Pharmacist
" Other: not specified
Interventions " INTERVENTION: AD (Three visits) + audit + feedback + skills training video
and workbook package + clinical guidelines + prompt sheet to assist with smokers’
excuses and self-exemptions + patient-mediated prompts + reminders for medical
records + patient brochures and free starter packs of nicotine replacement gum.
" CONTROL: same intensity program, but on cervical screening
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: recall of GPs advice about nicotine replacement patches
and gum, patient recall of assessment of smoking status and GP use of ‘quit dates’,
behavioural advice and provision of written materials
## Economic outcomes
## Other:
" Positive on: recall of GPs advice about nicotine replacement patches and gum
## Negative on:
" No effect on: Positive increases but not significant for: patient recall of
assessment of smoking status and GP use of ‘quit dates’, behavioural advice and
provision of written materials
Conclusion: Multifaceted intervention effective on promotion of use of nicotine replacement
therapy in GPs.
238 Academic Detailing – Supplement KCE reports 125
Study number 87. Study included
ZWAR, 2000
Zwar NA, Wolk J, Gordon JJ, Sanson-Fisher RW. Benzodiazepine prescribing by GP registrars. A trial of educational outreach. Aust Fam Physician. 2000;29(11):1104-7.
Quality appraisal score " 12/14
Country ## Europe
## US
## Canada
" Australia (New South Wales)
## Asia (specify)
Initiator " Not specified
Design " RCT
## Controlled study (prospective/retrospective):
## Before-after:
## Time series:
Objectives " To evaluate the effectiveness of an educational academic detailing program
about prescribing of benzodiazepines.
Setting " Physician’s office
## Primary care clinic
## Other (specify):
Population targeted ## Cancer
## Heart failure
## Neurodegenerative diseases
## Respiratory diseases
" Patients (long term users of ) benzodiazepines
Caregiver targeted " Family physician (= general practitioner): 157: 79 intervention; 78 control
## Specialist
## Type of physician not specified
Behavior targeted " Prescription of benzodiazepines
Who does academic detailing ## Nurse
KCE Reports 125 Academic Detailing – Supplement 239
" Physician
## Pharmacist
## Other
Interventions " INTERVENTION: AD (20 minute appointment) + guidelines on anxiety and
insomnia + leaflets for patients on relaxation techniques + a patient held aid to
managing the benzodiazepine withdrawal process
## CONTROL:
Multifaceted intervention? " YES
Outcomes ## Biological outcomes
## Psycho-social outcomes
" Process outcomes: rate of benzodiazepine prescribing for all indications, for
anxiety and sleep disorders.
## Economic outcomes
## Other:
" Positive on: Overall benzodiazepine prescribing (in continuing rather than
initial prescriptions), but no difference between groups
## Negative on:
## No effect on:
Conclusion: A marked decrease in benzodiazepine prescribing was seen in both intervention
and control groups but no differential effect due to the educational outreach visit
240 Academic Detailing – Supplement KCE reports 125
2 APPENDICES QUALITATIVE PART 2.1 APPENDIX A: PHONE SCRIPT (FRENCH)
« Bonjour, [X], du laboratoire SPIRAL, département de Science Politique de l’Université de Liège. Êtes-vous bien le Docteur [Y] ? Je vous contacte dans le cadre de l’étude KCE [si question sur la signification de KCE : « Il s’agit du Centre Fédéral d’Expertise des Soins de Santé, qui dépend du SPF Santé Publique »] sur l’évaluation de la visite du délégué médical indépendant sur la pratique des médecins généralistes.
Comme vous aviez marqué votre accord pour participer à cette enquête, vous avez reçu un courrier cette semaine à ce sujet. Donc, je vous contacte pour fixer un rendez-vous pour un entretien qui durera une vingtaine de minutes. Je suis dans votre région le [JJ] et le [JJ]/[MM]. Une de ces dates vous convient-elle ? »
(…)
« L’entretien sera enregistré, mais votre identité restera confidentielle : seul un groupe de chercheurs du SPIRAL connaîtra votre identité, qui n’apparaîtra nulle par sur les documents que nous produirons. »
2.2 APPENDIX B: MAIN FIVE QUESTIONS, USED AS A GUIDE FOR THE FIRST INTERVIEWS (FRENCH) Ces questions ont été pré-testées le 21 août chez un médecin généraliste. Il s’agit de questions définies comme incontournables, de guidelines, qui seront complétées lors des passations selon la grille disponible en Annexe C. Elles serviront essentiellement à amorcer et à cadrer l’entretien.
! Que pensez-vous des différents types d’information sur les médicaments en Belgique ? [Le but est ici de voir si les généralistes parlent spontanément de Farmaka.]
! Au sujet des informations qui vous ont été fournies par Farmaka, quelque chose a-t-il changé pour vous ces dernières années ?
! Que pensez-vous du niveau de formation des visiteurs indépendants ? Quelle est leur légitimité, leur crédibilité ?
! Recevez-vous des délégués médicaux privés, à quelle fréquence ? [Cette question, qui semble redondante par rapport à une étude KCE précédente, nous renseigne en fait sur les habitudes du médecin interrogé – elle permet aussi de voir quelle est la légitimité du délégué médical privé aux yeux du médecin.]
! Avez-vous autre chose à ajouter ?
En plus de ces questions, des informations seront récoltées systématiquement, comme :
! L’âge précis et le sexe du médecin ; ! L’interviewer notera si le médecin dispose d’un ordinateur sur son
bureau ; ! Les caractéristiques de la patientèle (observation, question) ; ! Les caractéristiques géographiques (milieu urbain, rural) ; ! La méthodologie de travail du médecin (seul, en association).
Il est à noter que la plupart de ces informations peuvent être observées et que seules quelques-unes d’entre elles feront l’objet de questions, dans les cas où l’observation (quartier du cabinet, salle d’attente) ne donnera pas de résultats suffisants.
KCE Reports 125 Academic Detailing – Supplement 241
2.3 APPENDIX C: CHARACTERISTICS OF FACE-TO-FACE INTERVIEWEES
Province Gender Age Work practice
Number of pharmaceutical delegates
Duration of the interview
Namur M 34 Medical centre Few 17’ Namur M 59 Associated None 40’ Namur M 56 Alone Average 8’
Liège M 34 Medical House + Hospital None 31’
Liège M 61 Alone A lot 35’ Bruxelles F 53 Alone Few 16’ Brabant Wallon F 49 Alone None 17’ Brabant Wallon M 56 Associated None 15’ Brabant Wallon F 36 Alone Very few 26’ Brabant Wallon M 35
Medical House + Social work Very few 16’
Brabant Wallon F 59 Medical House Very few 31’
Hainaut F 34 Medical House + Social work Few 15’
Hainaut F 33 Medical House Few 26’ Oost-Vlaanderen M 52 Alone None 16’ Oost-Vlaanderen M 56 Alone Very few 30’ Oost-Vlaanderen M 58 Alone Very few 33’ Limburg F 58 Alone None 30’ West-Vlaanderen M 54 Associated Few 8’ West-Vlaanderen M 64 Associated Average 20’ West-Vlaanderen M 61 Alone N/A 30’ West-Vlaanderen M 48 Alone Average 23’ West-Vlaanderen M 55 Alone A lot 15’ West-Vlaanderen M 54 Alone N/A 19’ West-Vlaanderen M 51 Alone Very few 30’ Antwerpen M 54 Associated A lot 25’ Antwerpen F 35 Associated None 16’ Antwerpen M 35 Associated Few 27’ Antwerpen M 58 Alone N/A 15’ Antwerpen M 54 Associated Very few 19’ Antwerpen M 51 Alone Very few 13’ Antwerpen M 58 Alone Average 21’ Antwerpen M 58 Alone N/A 30’
242 Academic Detailing – Supplement KCE reports 125
Antwerpen M 48 Alone Few 13’ Oost-Vlaanderen M 73 Alone Average 8’ Oost-Vlaanderen F 55 Alone Very few 20’ Oost-Vlaanderen M 71 Alone Average 11’ Vlaams Brabant F 37 Work Medicine N/A 13’ Vlaams Brabant M 50 Alone N/A 17’ Antwerpen M 56 Associated Few 20’ Antwerpen M 38 Associated None 20’
Caption for the “Number of pharmaceutical delegates” column: None: does not see any pharmaceutical delegate Very few: sees less than 15 pharmaceutical delegates a year Few: sees less than 30 pharmaceutical delegates a year Average: sees 1 or 2 delegates a week A lot: sees 6+ delegates a week
KCE Reports 125 Academic Detailing – Supplement 243
2.4 APPENDIX D. MAIN TOPICS TO BE INVESTIGATED, IN A GRID (FRENCH)
244 Academic Detailing – Supplement KCE reports 125
2.5 APPENDIX E: INVITATION MAIL TEXTS
2.5.1 Version in French
Docteur,
Dans le cadre d’une étude portant sur votre perception du projet « évaluation de l’impact de la visite des délégués médicaux indépendants », de son utilité, de son influence, de son adéquation aux besoins des médecins, etc., le Centre fédéral d’expertise des soins de santé (KCE) a chargé le SPIRAL, centre de recherche de l’Université de Liège, de procéder à des entretiens individuels ainsi qu’à la mise en œuvre d’un questionnaire en ligne.
Vous avez accepté de participer à cette étude nous vous en remercions. Votre avis est important pour notre recherche. Dans ce cadre, je me permets de prendre contact avec vous afin de vous inviter à participer à ce questionnaire en ligne.
Le processus est confidentiel. En un simple clic sur ce lien <http://www.mesydel.com/?language=french>, vous aurez accès à l’outil informatique Mesydel qui servira de support à ce questionnaire. Vos identifiant et mot de passe sont :
Identifiant : xxxxxx
Mot de passe : yyyyyy
Je vous serais très reconnaissante de bien vouloir compléter le questionnaire avant le dimanche 4 octobre prochain inclus. N’hésitez pas à me contacter – ou un autre membre de l’équipe – à tout moment ; nous sommes à votre disposition pour répondre à vos questions.
D’avance, je vous remercie pour votre précieuse collaboration et vous prie de croire, Docteur, en l’assurance de mes sentiments les meilleurs.
Stéphanie Vanhaeren
Chargée de recherche
Département de Science Politique de l’Université de Liège
Laboratoire de recherche SPIRAL
Téléphone : +32 (0) 4 366 46 97
E-mail : [email protected]
KCE Reports 125 Academic Detailing – Supplement 245
2.5.2 Version in Dutch
Beste Doktor,
In het kader van een lopende studie om de impact van zelfstandig medisch afgevaardigden op het voorschrijfgedrag van huisartsen te evalueren, heeft het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) het SPIRAL (een kenniscentrum van de ULg) opdracht gegeven om face-to-face gesprekken en een online vragenlijst te boeken.
U heeft aanvaard om aan deze studie deel te nemen, waarvoor wij u danken.
Uw mening is belangrijk voor ons onderzoek. In dit kader neem ik contact met u op om u vriendelijk uit te nodigen deel te nemen aan deze online vragenlijst.
Het proces is vertrouwelijk. Met een eenvoudige klik op de link http://www.mesydel.com/?language=dutch krijgt u toegang tot het informatienetwerk Mesydel, met hierop onze vragenlijst. Uw login en paswoord zijn:
Login: xxxxxx
Passwoord: yyyyyy
Deadline: 04/10/2009
Aarzel niet om mij (of een ander lid van ons team) te contacteren. Wij staan steeds tot uw beschikking om al uw vragen te beantwoorden.
Ik dank u voor uw waardevolle medewerking.
Met de meeste hoogachting,
Nick Geukens
Onderzoeker
Departement Politieke Wetenschappen – Universiteit van Luik
SPIRAL kenniscentrum
Telefoon: +32 (0) 4 366 46 97
E-mail: [email protected]
246 Academic Detailing – Supplement KCE reports 125
2.6 APPENDIX F: WEB WELCOME (LOGGED-IN) TEXT
2.6.1 Version in French
Docteur,
Vous avez donné votre accord pour participer au Mesydel du projet « évaluation de l’impact de la visite des délégués médicaux indépendants ». Ce dernier est organisé par le Centre fédéral d’expertise des soins de santé. La partie enquête est mise en œuvre par le centre de recherche SPIRAL de l’Université de Liège.
La date limite pour répondre au questionnaire est le dimanche 4 octobre 2009. D’ici-là, vous aurez la possibilité d’enrichir à tout moment vos réponses via cette interface.
Le processus est tout à fait anonyme et la seule contrainte à respecter pour remplir le questionnaire est d’argumenter vos réponses. Le temps pour répondre aux neuf questions est estimé à une demi-heure au maximum.
Au nom de l’équipe du SPIRAL, je vous remercie pour votre précieuse participation. Si vous êtes intéressé par les résultats de cette étude, laissez-nous votre adresse mail. Nous nous ferons un plaisir de vous contacter lors de sa publication. N’hésitez pas à me contacter – ou un autre membre de l’équipe – à tout moment ; nous sommes à votre disposition pour répondre à vos questions.
Stéphanie Vanhaeren
Chargée de recherche
Département de Science Politique de l’Université de Liège
Laboratoire de recherche SPIRAL
Téléphone : +32 (0) 4 366 46 97
E-mail : [email protected]
KCE Reports 125 Academic Detailing – Supplement 247
2.6.2 Version in Dutch
Beste Doktor,
U hebt geaccepteerd om deel te nemen aan de studie over de evaluatie van zelfstandig medisch aanvaardigden. Het KCE is verantwoordelijk voor deze studie. Een deel ervan wordt aan het SPIRAL – een kenniscentrum van de ULg - toevertrouwd.
De deadline om de vragenlijst in te vullen is 4 oktober 2009. Het proces is vertrouwelijk en duurt ongeveer een half uur. U kunt uw vragen tot de deadline op ieder ogenblik blijven aanpassen en aanvullen.
In naam van SPIRAL dank ik u voor uw deelname. Indien u geïnteresseerd bent in de resultaten van ons onderzoek, gelieve dan uw e-mail adres te geven. Het zal ons plezier doen u van de publicatie op de hoogte te stellen. Aarzel niet om mij (of een ander teamlid) te contacteren. Wij staan steeds tot uw beschikking om al uw vragen te beantwoorden.
Ik dank u voor uw waardevolle medewerking.
Met de meeste hoogachting,
Nick Geukens
Onderzoeker
Departement Politieke Wetenschappen – Universiteit van Luik
SPIRAL kenniscentrum
Telefoon: +32 (0) 4 366 46 97
E-mail: [email protected]
248 Academic Detailing – Supplement KCE reports 125
2.7 APPENDIX G: MESYDEL PARTICIPANTS
2.7.1 Contacted GPs for the Mesydel session: response rates
Round 1
All GPs who accepted to participate by letter (297 GPs) received a voucher. By sending back this voucher to KCE, they gave Spiral their e-mail address and agreed to participate to the study.
At the end of the first round (October 5th), 152 GPs sent their voucher back to KCE with their e-mail address, therefore accepting to participate to the Mesydel.
Figure 4. Attrition table for the first round of the Mesydel
A few of them did provide an incorrect e-mail address. We were able to fix most of them by phoning the GPs and therefore to encode and invite 147 of the 152 GPs (26 French-speaking and 121 Dutch-speaking). By not having the e-mail address of all the GPs and having recourse to the voucher system, we lost half of the sample for the Mesydel (50,5%). The KCE original listing based on the original Farmaka sample appears greyed in Figure 4.
As of October 5th, 18 (on 26, i.e. 69,2%) French-speaking GPs and 93 (on 121, i.e. 76,9%) Dutch-speaking GPs answered the Mesydel (a total of 111 GPs, i.e. 75,6% of the GPs who sent their voucher back to KCE).
B. Round 2
At the end of the Mesydel session, 154 GPs had send their voucher back to KCE with their e-mail addresses, therefore accepting to participate to the Mesydel.
KCE Reports 125 Academic Detailing – Supplement 249
Figure 5. Attrition table for the second round of the Mesydel
After fixing a few more e-mail addresses, we invited 152 of the 154 GPs (28 French-speaking and 124 Dutch-speaking).
At the end of the second round, 21 (on 28, i.e. 75%) French-speaking GPs and 87 (on 124, i.e. 70,1%) Dutch-speaking GPs answered the Mesydel (a total of 108 GPs, i.e. 71% of the GPs who sent their voucher back to KCE).
2.7.2 Characteristics of the Mesydel participants
Province Gender Age Work Practice
Number of pharmaceutical delegates
Round 1 Round 2
Antwerp M 50 Alone A lot X X Antwerp M 58 Alone Few X X Antwerp M 58 Alone A lot X X Antwerp M 55 Alone A lot X X Antwerp F 43 Alone Very few X Antwerp M 60 Alone N/A X X Antwerp F 37 Alone A lot X X Antwerp M 50 Alone A lot X X Antwerp M 38 Alone Few X X Antwerp M 53 Alone A lot X X Antwerp M 54 Alone A lot X X Antwerp M 32 Associated Few X X Antwerp M 35 Associated Few X X Antwerp F 46 Associated Average X X Antwerp M 50 Associated Few X X Antwerp M 44 Associated Few X Antwerp M N/A Associated Few X X Antwerp M 65 Associated Very few X X Antwerp M 32 Associated Few X X Antwerp F 37 Associated Very few X X Antwerp M 50 Associated None X Antwerp M N/A N/A N/A X Antwerp M N/A N/A N/A X Antwerp M N/A N/A N/A X Antwerp M N/A N/A N/A X Antwerp M N/A N/A N/A X Antwerp F N/A N/A N/A X Antwerpen M 67 Alone Very few X X Antwerpen M 51 Alone Few X X Antwerpen M 53 Alone N/A X Antwerpen M 62 Associated None X X
250 Academic Detailing – Supplement KCE reports 125
Brabant Wallon F 49 Alone None X X Brabant Wallon M 49 Alone A lot X X Brabant Wallon F 51 Associated Average X X Brabant Wallon M 57 Associated Very few X Brabant Wallon M 34 Associated Few X X Brabant Wallon M 36 Medical
House Few X X
Brabant Wallon M N/A N/A N/A X Brabant Wallon F N/A N/A N/A X Hainaut M 60 Alone None X X Hainaut F 33 Associated Average X X Hainaut M 53 Associated None X X Hainaut M 48 Medical
House None X X
Hainaut M 61 Medical House
None X X
Hainaut F 47 Medical House
Few X X
Hainaut F 54 Medical House
Very few X X
Hainaut F 35 Medical House
Few X X
Hainaut F N/A N/A N/A X X Liège M 36 Medical
House + Hospital
None X X
Limburg M 60 Alone Few X X Limburg F 41 Alone Few X X Limburg M 45 Alone A lot X X Limburg M 58 Alone A lot X Limburg F 58 Alone None X Limburg M 61 Associated Very few X X Limburg M 55 Associated Few X X Limburg M N/A N/A N/A X Namur M 51 Alone Average X X Namur M 35 Associated A lot X X Namur M N/A N/A N/A X Namur M N/A N/A N/A X Oost-Vlaanderen M 46 Alone A lot X X Oost-Vlaanderen M 65 Alone Few X X Oost-Vlaanderen M 51 Alone A lot X X Oost-Vlaanderen F 55 Alone Very few X X Oost-Vlaanderen M 59 Alone Few X X Oost-Vlaanderen M 56 Alone A lot X X Oost-Vlaanderen M 42 Alone Few X X Oost-Vlaanderen M 63 Alone Few X X Oost-Vlaanderen F 30 Alone A lot X X Oost-Vlaanderen M 47 Alone N/A X X Oost-Vlaanderen M 56 Alone Few X X Oost-Vlaanderen M 52 Alone None X X Oost-Vlaanderen M 53 Alone A lot X X Oost-Vlaanderen M 48 Alone Few X X Oost-Vlaanderen F 56 Alone Few X X Oost-Vlaanderen M 71 Alone A lot X X Oost-Vlaanderen M 64 Alone Very few X Oost-Vlaanderen M 72 Associated Average X X Oost-Vlaanderen M 51 Associated Average X X Oost-Vlaanderen M 33 Associated None X X
KCE Reports 125 Academic Detailing – Supplement 251
Oost-Vlaanderen M 61 Associated A lot X X Oost-Vlaanderen M 56 Associated Few X Oost-Vlaanderen F 37 Associated Few X Oost-Vlaanderen M 57 Associated Very few X X Oost-Vlaanderen M 59 Associated Few X X Oost-Vlaanderen M 53 Associated A lot X X Oost-Vlaanderen M 43 Associated Few X X Oost-Vlaanderen M 55 Associated Few X X Oost-Vlaanderen M 52 Associated A lot X X Oost-Vlaanderen M 59 Associated Few X X Oost-Vlaanderen M 50 Associated Few X Oost-Vlaanderen M N/A N/A N/A X X Oost-Vlaanderen M N/A N/A N/A X Vlaams Brabant M 56 Alone Very few X X Vlaams Brabant M 50 Alone A lot X Vlaams Brabant F 37 Associated Average X X Vlaams Brabant F 64 Associated None X X Vlaams Brabant M 40 Associated A lot X X Vlaams Brabant F 49 Associated A lot X X Vlaams Brabant M N/A N/A N/A X West-Vlaanderen M 65 Alone Average X X West-Vlaanderen M 59 Alone None X X West-Vlaanderen F 49 Alone Few X X West-Vlaanderen M 49 Alone N/A X X West-Vlaanderen M 51 Alone Very few X X West-Vlaanderen M 61 Alone A lot X X West-Vlaanderen M 57 Alone Few X X West-Vlaanderen M 49 Alone A lot X X West-Vlaanderen M 57 Alone Few X West-Vlaanderen M 57 Alone A lot X West-Vlaanderen M 55 Alone A lot X West-Vlaanderen M 48 Alone Few X X West-Vlaanderen M 58 Alone Few X West-Vlaanderen M 54 Alone +
Social work A lot X X
West-Vlaanderen F 34 Associated Average X X West-Vlaanderen M 55 Associated Average X X West-Vlaanderen M 53 Associated None X X West-Vlaanderen F 35 Associated Few X X West-Vlaanderen M 38 Associated None X X West-Vlaanderen F 31 Associated Very few X X West-Vlaanderen M N/A N/A N/A X X West-Vlaanderen M N/A N/A N/A X West-Vlaanderen M N/A N/A N/A X West-Vlaanderen M N/A N/A N/A X West-Vlaanderen M N/A N/A N/A X
Caption for the “Number of pharmaceutical delegates” column: None: does not see any pharmaceutical delegate Very few: sees less than 15 pharmaceutical delegates a year Few: sees less than 30 pharmaceutical delegates a year Average: sees 1 or 2 delegates a week A lot: sees 6+ delegates a week
252 Academic Detailing – Supplement KCE reports 125
2.8 APPENDIX H: QUESTIONS FOR THE FIRST MESYDEL ROUND
2.8.1 Version in French
1. L’information fournie par les délégué(e)s Farmaka est-elle applicable dans votre pratique ?
2. L’information fournie par les délégué(e)s Farmaka est-elle utile à votre pratique ?
3. Selon vous, les délégué(e)s Farmaka ont-ils une formation adéquate ?
4. Quelle serait la formation minimale requise pour être délégué(e) Farmaka ?
5. Est-ce que les délégué(e)s Farmaka ont changé votre pratique professionnelle?
6. Quel est ou quels sont les sujets qui vous a ou ont été présenté(s) par le ou la délégué(e) Farmaka?
7. Vous sentiez-vous concerné par ces sujets?
8. Dans quelle mesure compareriez-vous les visites de délégués médicaux indépendants à celles des représentants commerciaux?
9. Quelle est votre opinion sur le rôle des firmes pharmaceutiques dans le processus d’information médicale?
10. Quel rôle devrait jouer à vos yeux l’État dans le processus d’information médicale?
11. Pouvez-vous nous préciser (en quelques mots si nécessaire) :
a. Combien d’heures vous travaillez par semaine ;
b. L’organisation de votre cabinet (vous travaillez seul, en collaboration avec d’autres médecins, en maison médicale, etc.) ;
c. Votre type de patientèle (âgée, précaire, faible niveau d’instruction, etc.);
d. Le nombre de représentants commerciaux que vous recevez par semaine ou par mois ;
e. Votre âge.
2.8.2 Version in Dutch
1. Geven de artsenbezoekers van Faramaka informatie die u in uw praktijk kan toepassen?
2. Verschaffen de artsenbezoekers van Farmaka nuttige informatie voor uw praktijk?
3. Hebben de artsenbezoekers van Farmaka volgens u een adequate vorming genoten?
4. Wat zou volgens u het minimum niveau moeten zijn om arstenbezoeker te kunnen worden?
5. Hebben de arstenbezoekers van Farmaka uw professionele praktijk gewijzigd?
6. Welke thema(s) werde(n) u door de artsenbezoekers van Farmaka voorgesteld?
7. Gaan deze thema’s u aan?
8. In welke mate kunt u de bezoeken van de onafhankelijke artsenbezoekers vergelijken met die van de vertegenwoordigers van de medische firma’s?
9. Wat denkt u over de rol van de farmaceutische firma’s in de verstrekking van medische informatie?
KCE Reports 125 Academic Detailing – Supplement 253
10. Welke rol zou de Staat volgens u moeten spelen in de verstrekking van medische informatie?
11. Kunt u verduidelijken of uitleggen (in enkele woorden):
a. Hoeveel uur werkt u gemiddeld per week?;
12. De organisatie van uw medisch kabinet (groeps-praktijk of solo);
13. Uw patiënten (leeftijd, sociaal niveau,…);
14. Het aantal medisch afgevaardigden dat u per week of per maand ontvangt;
15. Uw leeftijd.
2.9 APPENDIX I. QUESTIONS FOR THE SECOND MESYDEL ROUND
2.9.1 Version in French
1. Le rôle de l’État sur les habitudes de prescription des médecins a suscité des polémiques lors du premier tour de ce questionnaire. :
Nous avons pu lire :
! « Avec les visiteurs médicaux indépendants, on a le sentiment d’être dans un processus de formation, un peu comme à un recyclage (formation continue), mais sur un sujet qui m’intéresse. Ça devrait peut-être compter pour l’accréditation. »
! « L’État ne devrait avoir aucun rôle [dans nos habitudes de prescription]. J’ai un regard très soupçonneux par rapport à l’État. Ils nous poussent à prescrire toujours moins cher. »
Pourriez-vous vous situer quant à ces deux positions ?
Seriez-vous disposé(e) à modifier vos habitudes de prescription ? Si oui, pensez-vous qu’une contrepartie soit nécessaire ?
2. Lors du premier tour de ce questionnaire, nous avons pu lire :
! « [Le visiteur Farmaka est] un scientifique concerné par la santé des patients et soucieux d’améliorer la qualité de la médecine sur base de critères validés internationalement. »
! « [Les visiteurs Farmaka] sont politiquement teintés. Je n’ai pas besoin qu’un vienne m’apprendre la science sous un couverture idéologique – c’est un peu ce qu’ils font. »
Avez-vous le sentiment que le visiteur Farmaka a un discours plutôt scientifique ou plutôt politique ?
3. Lors du premier tour de ce questionnaire, nous avons pu lire :
! « [Nous devrions avoir accès à une] information la plus objective possible comme déjà avec le CBIP. Pourquoi pas offrir aussi une sorte de hotline ? »
! « Ils devraient nous donner accès à la bibliothèque Cochrane. Là, on aurait tout ce qu’il nous faut ! »
! « Si Farmaka s’adressait aussi aux patients, ça faciliterait mon travail, parce qu’il y a plein d’infos que je ne devrais plus donner. »
Pensez-vous que Farmaka devrait étendre ses services (via une ligne téléphonique, la fourniture d’accès à des bibliothèques en ligne, ou même donner une information directe aux patients) ?
Si oui, quel(s) service(s) vous paraîtraient les plus adéquats ?
4. Lors de nos entretiens, nous avons entendu :
254 Academic Detailing – Supplement KCE reports 125
! « Je sais que mes confrères pensent différemment, mais j’ai une très haute opinion de Farmaka ! »
! « Sans Farmaka (et le CBIP ou encore les folia) nous serions manipulés dans tous les sens. »
Comment vous situez-vous par rapport à ces citations ?
5. Lors de nos entretiens, nous avons entendu :
« Vous savez, un de mes rôles, moi, c’est d’informer mon patient pour qu’il soit juge de sa maladie. Mais je ne pense pas que la majorité de mes confrères partage ma vision. »
! Êtes-vous d’accord avec cette affirmation ?
! Vous-même, vous sentez-vous représentatif des médecins généralistes belges ? Quelle(s) serai(en)t votre/vos particularités par rapport à vos confrères ?
6. Dans votre pratique, trouvez-vous plus facile de gérer une incertitude liée à un traitement
! selon que l’information vous est communiquée via un spécialiste faisant autorité ;
! selon des études basées sur des preuves scientifiques.
7. Pensez-vous que le service rendu par Farmaka devrait s’étendre à tous les médecins généralistes de Belgique ?
Pour quelle(s) raison(s) ?
8. Ceci conclut les deux tours de notre enquête en ligne.
Avez-vous des suggestions, des sujets, des idées qui n’ont pas été abordées et que vous trouvez essentielles quant aux visiteurs indépendants ?
2.9.2 Version in Dutch
1. De rol van de overheid op het voorschrijfgedrag van huisartsen heeft controverse opgewekt in de eerste ronde van de vragenlijst.
Uit de eerste ronde van de vragenlijst konden we afleiden:
! "Bij de onafhankelijke artsenbezoekers hadden we het gevoel dat we ons in een soort bijscholing bevonden, een beetje een opfrissing (continue navorming), maar dan van een onderwerp dat me interesseert. Misschien zou het voor accreditering in aanmerking moeten komen."
! "De overheid zou geen rol mogen spelen [in ons voorschrijfgedrag]. Ik kijk zeer wantrouwig naar de overheid. Ze pushen ons altijd om goedkoper voor te schrijven."
Hoe situeert u zichzelf ten aanzien van deze twee visies?
Bent u bereid uw voorschrijfgedrag aan te passen? Indien ja, vindt u dan dat daar iets zou moeten tegenover staan?
2. Uit de eerste ronde van de vragenlijst konden we afleiden:
! "[De artsenbezoeker van Farmaka is] een wetenschapper, begaan met de gezondheid van patiënten en gericht op de kwaliteitsverbetering van (niet-)medicamenteuze behandeling, gebaseerd op internationaal gevalideerde criteria."
! "[De artsenbezoekers van Farmaka zijn] politiek gekleurd. Ik heb niemand nodig om me wetenschap te komen aanleren onder een ideologische paraplu, en dat doet het KCE een beetje."
Heeft u het gevoel dat de artsenbezoeker van Farmaka een meer wetenschappelijk of een meer politiek discours volgt?
3. Uit de eerste ronde van de vragenlijst konden we afleiden:
KCE Reports 125 Academic Detailing – Supplement 255
! "[We zouden toegang moeten hebben tot] de meest neutrale informatie mogelijk, zoals we nu al hebben met het BCFI. Waarom bieden ze ook niet een soort hotline aan?"
! "Ze zouden ons toegang moeten geven tot de Cochrane Library. Daar zouden we alles vinden wat we nodig hebben!"
! "Als Farmaka ook met patiënten zou praten, zou dit mijn eigen werk vergemakkelijken, omdat er veel informatie zou zijn die ik zelf niet meer zou moeten geven."
Denkt u dat Farmaka zijn diensten zou moeten uitbreiden (telefonisch, door toegang te verschaffen tot online bibliotheken, of zelfs door rechtstreeks informatie te verschaffen aan de patiënten zelf)?
Indien ja, welke dienst(en) zou u als de meest afdoende beschouwen?
4. Tijdens de interviews hoorden we:
! "Ik weet dat mijn collega’s er anders over denken, maar ik sta erg positief tegenover Farmaka!"
! "Zonder Farmaka (en het BCFI en de Folia) zouden we gemanipuleerd worden langs alle kanten."
Hoe situeert u zichzelf ten aanzien van deze twee visies?
5. Tijdens de interviews hoorden we:
"Weet u, één van mijn rollen, voor mij althans, is mijn patiënten te informeren zodat hij/zij in staat is om zelf te oordelen over zijn/haar ziekte. Maar ik denk niet dat de meerderheid van mijn collega’s mijn visie deelt."
! Bent u het met dit statement eens?
! Beschouwt u zichzelf als een vertegenwoordiger van de Belgische huisartsen? Wat zou u zelf als uw (eventuele) specifieke kenmerken beschouwen in vergelijking met uw collega’s?
6. Vindt u het gemakkelijker om een onzekerheid ten aanzien van een bepaalde behandeling aan te pakken:
! overeenkomstig de visie van een specialist, een autoriteit in zijn/haar domein;
! overeenkomstig studies gebaseerd op wetenschappelijke bewijzen.
7. Vindt u dat de diensten aangeboden door Farmaka uitgebreid zouden moeten worden tot alle huisartsen in België?
Om welke reden(en)?
8. Hiermee besluiten we de tweede ronde van onze online vragenlijst.
Heeft u suggesties, topics, ideeën die nog niet werden aangesproken en die u essentieel acht ten aanzien van de onafhankelijke artsenbezoekers?
256 Academic Detailing – Supplement KCE reports 125
2.10 APPENDIX J: DISCUSSION OF THE MESYDEL QUESTIONS
2.10.1 Round 1
The questions for the first round of the Mesydel were exploratory questions and modelled against the behaviour change theory. We analysed them in a classical way (by reading them and analysing answers sequentially). We were not able to apply a methodology based on the grounded theory, both because they were written with another framework in mind and because it would not have made much sense for exploratory questions (see appendix H for the questions in French and in Dutch.).
2.10.2 Round 2
The questions for the second round of the Mesydel were the final ones. They were written so that the answers could be analyzed with a methodology based on the grounded theory. In this section, we briefly illustrate the method of the tag clouds (questions are in English in this appendix, see appendix I the original versions).
Question 1
The role of the State on the prescribing behaviour of GP’s has generated a lot of controversy in the first round of the questionnaire.
In the first round of the questionnaire, we read:
! "With the independent medical visitors, we have the feeling of being in a process of training, just as a refresher (continuing education), but on a subject that interests me. Perhaps it should count for accreditation."
! "The State should have no role [in our prescribing habits]. I look very suspiciously at the State. They push us to always prescribe cheaper."
How do you stand in relation to these two visions?
Would you be willing to change your prescribing behaviour? If yes, do you think that a return is necessary?
Figure 3: Tags for the French Mesydel question 1, round 2
Figure 4: Tags for the Dutch Mesydel question 1, round 2
In this question, we searched to:
! dig further the question of the State perception by GP’s;
! see how GP’s see the role of the State in their prescribing behaviour;
! if a return would be welcome or necessary in order for GP’s to accept to meet Farmaka visitors.
Question 2
In the first round of the questionnaire, we read:
! "[The Farmaka visitor is] a scientist concerned with the health of patients and willing to improve the quality of medicine based on internationally validated criteria."
! "[Farmaka visitors] are politically tainted. I don’t need people to teach me science under an ideological umbrella – it’s a bit what they do."
KCE Reports 125 Academic Detailing – Supplement 257
Do you feel that the Farmaka visitor has a rather scientific or rather political discourse?
Figure 5: Tags for the French Mesydel question 2, round 2
Figure 6: Tags for the Dutch Mesydel question 2, round 2
In this question, we searched to see if the Farmaka visitor was seen as being scientific or political. A third answer emerged: economical.
Question 3
In the first round of the questionnaire, we read:
! "[We should have access to] the most objective information possible, as we already have with the CBIP. Why not also provide some sort of hotline?"
! "They should give us access to the Cochrane Library. There, we would have everything we need!"
! "If Farmaka was aimed at patients too, it would facilitate my work, because there would be many details that I would not have to give myself anymore."
Do you think Farmaka should extend its services (through a telephone line, providing access to online libraries, or even by providing direct information to patients)?
If yes, what service(s) do you think would be most appropriate?
Figure 7: Tags for the French Mesydel question 3, round 2
Figure 8: Tags for the Dutch Mesydel question 3, round 2
In this question, we searched to:
! test if an online service or a hotline would be of interest to the GP’s and how they would like to see it implemented.
! test if an access to the Cochrane Library (and other publications of the same kind) would interest the GP’s;
! test if Farmaka should extend its services to patients.
Question 4
During our interviews, we heard:
! "I know my colleagues feel differently, but I have a very high opinion of Farmaka!"
! "Without Farmaka (and the CBIP/BCFI and the folia) we would be manipulated from all sides."
How do you stand in relation to these views?
Figure 9: Tags for the French Mesydel question 4, round 2
258 Academic Detailing – Supplement KCE reports 125
Figure 10: Tags for the Dutch Mesydel question 4, round 2
In this question, we searched to:
! test the visibility of Farmaka;
! test the perception of Farmaka;
! test if Farmaka was an efficient counterweight to pharmaceutical delegates.
Question 5
During our interviews, we heard:
"You know, one of my roles in my opinion is to inform my patients so that they can be a judge to their own illness. But I don’t think the majority of my colleagues share my view."
! Do you agree with this statement?
! Do you feel yourself a representative of the Belgian GP’s? What would be your characteristic features wehn compared to your colleagues?
Figure 11: Tags for the French Mesydel question 5, round 2
Figure 12: Tags for the Dutch Mesydel question 5, round 2
In this question, we searched to:
! see if the GP’s have open discussions with their patients or have a more paternalistic posture;
! see if the GP’s feel representative of the “Belgian GP”.
Question 6
In your practice do you find it easier to manage uncertainty related to a treatment
! according to the view of a who has an authority in his/her domain;
! according to studies based on scientific evidence.
Figure 13: Tags for the French Mesydel question 6, round 2
Figure 14: Tags for the Dutch Mesydel question 6, round 2
In this question, we searched to:
! see if uncertainties related to a treatment are solved through EBM or ABM (“Authority Based Medicine);
! test the relation between GP’s and specialists.
Question 7
Do you think the services provided by Farmaka should be extended to all GP’s in Belgium?
For what reason(s)?
KCE Reports 125 Academic Detailing – Supplement 259
Figure 15: Tags for the French Mesydel question 7, round 2
Figure 16: Tags for the Dutch Mesydel question 7, round 2
In this question, we searched to see if Farmaka should extend its services to all Belgian GP’s and to make emerge various opinions about the topic.
Question 8
This concludes the two rounds of our online survey.
Do you have any suggestions, topics, ideas that have not been addressed and that you feel are essential when it comes to independent visitors?
Figure 17: Tags for the French Mesydel question 8, round 2
Figure 18: Tags for the Dutch Mesydel question 8, round 2
This question was essentially there to check if we had not forgotten important topics. Nothing new emerged; we can therefore conclude that the two Mesydel rounds covered the important parts about the topic. This question also served as information for the GP’s that the Mesydel session was now finished for them.
260 Academic Detailing – Supplement KCE reports 125
3 APPENDICES - ANALYSIS OF IMA DATABASE 3.1 DIABETES TOPIC
3.1.1 Descriptive statistics: number of patients by GP – Overall Population
Statistics Value N 156 Mean (sd) 42 (26) Median 41 Q1 – Q3 25 – 55 Min – Max 1 – 156
3.1.2 Age distribution of the patients analyzed for Diabetes – Overall Population
Statistics Value N 6584 Mean (sd) 68 (13) Median 69 Q1 – Q3 60 – 77 Min – Max 18 - 101
3.1.3 Number (%) of patients by type of therapy given before and after the AD visit for the diabetes topic – Overall Population
Therapy given Before AD Visit
Therapy given After the AD visit
0 1 2 3 4 5 6 7 8 9 Total
0 0 733 236 0 36 118 47 14 5 4 1193
0.00 11.13 3.58 0.00 0.55 1.79 0.71 0.21 0.08 0.06 18.12
1 457 1614 45 35 18 76 60 5 2 4 2316
6.94 24.51 0.68 0.53 0.27 1.15 0.91 0.08 0.03 0.06 35.18
2 208 49 818 16 4 140 2 11 2 3 1253
3.16 0.74 12.42 0.24 0.06 2.13 0.03 0.17 0.03 0.05 19.03
4 61 17 3 7 161 3 39 12 0 7 310
0.93 0.26 0.05 0.11 2.45 0.05 0.59 0.18 0.00 0.11 4.71
5 95 73 135 2 4 492 6 6 11 4 828
1.44 1.11 2.05 0.03 0.06 7.47 0.09 0.09 0.17 0.06 12.58
6 49 70 2 60 47 0 207 3 1 11 450
0.74 1.06 0.03 0.91 0.71 0.00 3.14 0.05 0.02 0.17 6.83
7 13 2 18 12 14 8 11 42 4 5 129
0.20 0.03 0.27 0.18 0.21 0.12 0.17 0.64 0.06 0.08 1.96
8 6 2 2 7 0 7 1 6 11 0 42
0.09 0.03 0.03 0.11 0.00 0.11 0.02 0.09 0.17 0.00 0.64
9 5 0 1 4 4 3 5 7 0 34 63
0.08 0.00 0.02 0.06 0.06 0.05 0.08 0.11 0.00 0.52 0.96
Total 894 2560 1260 143 288 847 378 106 36 72 6584
13.58 38.88 19.14 2.17 4.37 12.86 5.74 1.61 0.55 1.09 100.00
0 = None/ No data available 1 = Monotherapy – Metformin (Recommended) 2 = Monotherapy – Sulfonylurea (Recommended)
KCE Reports 125 Academic Detailing – Supplement 261
3 = Monotherapy – Insulin 4 = Monotherapy – Others 5 = Bitherapy – Metformin & Sulfonylurea (Recommended) 6 = Bitherapy – Metformin & Others 7 = Bitherapy – Others 8 = Tritherapy – Metformin & Sulfonylurea + Insulin (Recommended) 9 = Others
3.1.4 Number (%) of Patients by type of therapy given before and after the AD visit for diabetes topic – “Complete” Cases Subgroup
Therapy given Before AD Visit
Therapy given After the AD visit
1 2 3 4 5 6 7 8 9 Total
1 1614 45 35 18 76 60 5 2 4 1859
35.89 1.00 0.78 0.40 1.69 1.33 0.11 0.04 0.09 41.34
2 49 818 16 4 140 2 11 2 3 1045
1.09 18.19 0.36 0.09 3.11 0.04 0.24 0.04 0.07 23.24
4 17 3 7 161 3 39 12 0 7 249
0.38 0.07 0.16 3.58 0.07 0.87 0.27 0.00 0.16 5.54
5 73 135 2 4 492 6 6 11 4 733
1.62 3.00 0.04 0.09 10.94 0.13 0.13 0.24 0.09 16.30
6 70 2 60 47 0 207 3 1 11 401
1.56 0.04 1.33 1.05 0.00 4.60 0.07 0.02 0.24 8.92
7 2 18 12 14 8 11 42 4 5 116
0.04 0.40 0.27 0.31 0.18 0.24 0.93 0.09 0.11 2.58
8 2 2 7 0 7 1 6 11 0 36
0.04 0.04 0.16 0.00 0.16 0.02 0.13 0.24 0.00 0.80
9 0 1 4 4 3 5 7 0 34 58
0.00 0.02 0.09 0.09 0.07 0.11 0.16 0.00 0.76 1.29
Total 1827 1024 143 252 729 331 92 31 68 4497
40.63 22.77 3.18 5.60 16.21 7.36 2.05 0.69 1.51 100.00
1 = Monotherapy – Metformin (Recommended) 2 = Monotherapy – Sulfonylurea (Recommended) 3 = Monotherapy – Insulin 4 = Monotherapy – Others 5 = Bitherapy – Metformin & Sulfonylurea (Recommended) 6 = Bitherapy – Metformin & Others 7 = Bitherapy – Others 8 = Tritherapy – Metformin & Sulfonylurea + Insulin (Recommended) 9 = Others
262 Academic Detailing – Supplement KCE reports 125
3.1.5 Volume (in number of Defined Daily Doses) by Group of Medications, Population and Semesters – Diabetes
Volume in number of DDDs
N Mean Std Median Q1 Q3 Min Max
Medication Group population semestre
80 341.31 402.86 158.67 74.67 494.67 18.67 1829.34 Glitazones Visited GPs 2006-S1
2006-S2 76 347.48 376.85 205.34 93.34 541.33 18.67 1642.67
2007-S1 82 355.01 373.27 214.67 112.00 448.01 14.00 1810.66
2007-S2 77 378.79 412.29 224.00 112.00 485.34 14.00 2183.99
2008-S1 75 398.72 433.09 224.00 112.00 504.00 18.67 2165.32
2008-S2 73 359.40 402.90 224.00 93.34 466.67 18.67 1829.32
Overall GPs 2006-S1 6432 258.04 312.87 149.34 70.00 336.00 0.00 4242.02
2006-S2 6609 259.79 316.88 149.33 74.67 336.00 0.00 4624.70
2007-S1 6710 279.60 335.31 168.00 74.67 354.67 14.00 4703.98
2007-S2 6724 272.37 325.21 168.00 74.67 354.67 0.00 4741.30
2008-S1 6403 292.04 350.56 186.67 74.67 373.34 0.00 5058.65
2008-S2 6128 302.83 367.24 186.67 74.67 392.00 14.00 5319.97
KCE Reports 125 Academic Detailing – Supplement 263
Volume in number of DDDs
N Mean Std Median Q1 Q3 Min Max
Metformin Visited GPs 2006-S1 148 2290.27 1732.81 1992.25 1066.75 3261.25 15.00 10207.50
2006-S2 149 2315.58 1722.86 2072.00 1081.00 2977.50 42.50 9395.00
2007-S1 149 2540.19 1847.33 2219.00 1170.00 3490.00 30.00 11068.50
2007-S2 153 2600.99 1890.20 2377.00 1198.00 3450.00 15.00 10967.50
2008-S1 155 2872.65 2098.09 2519.50 1186.00 4121.00 75.00 11862.00
2008-S2 155 3018.93 2132.44 2675.00 1329.50 4254.50 57.50 11053.50
Overall GPs 2006-S1 17094 1504.20 1848.73 915.00 127.50 2266.50 15.00 41077.50
2006-S2 17258 1503.96 1834.01 907.50 127.50 2287.50 15.00 41766.00
2007-S1 17229 1627.86 1998.23 987.50 136.00 2468.50 0.00 38453.50
2007-S2 17525 1639.94 1998.89 970.50 127.50 2533.50 15.00 40278.00
2008-S1 17925 1833.11 2298.22 1053.50 127.50 2822.00 0.00 43457.00
2008-S2 17993 1870.97 2306.01 1064.50 127.50 2920.00 0.00 41649.50
264 Academic Detailing – Supplement KCE reports 125
Volume in number of DDDs
N Mean Std Median Q1 Q3 Min Max
Metformin & derivates of Sulfonylurea
Visited GPs 2006-S1 64 598.13 687.44 420.00 240.00 750.00 60.00 3780.00
2006-S2 72 485.83 532.97 300.00 150.00 690.00 60.00 2940.00
2007-S1 73 527.67 621.69 300.00 180.00 660.00 60.00 3540.00
2007-S2 77 472.21 551.57 240.00 180.00 600.00 60.00 2640.00
2008-S1 79 535.44 661.17 240.00 180.00 660.00 60.00 3480.00
2008-S2 80 495.00 670.21 240.00 120.00 600.00 60.00 4200.00
Overall GPs 2006-S1 5189 491.16 701.33 240.00 120.00 600.00 0.00 15660.00
2006-S2 5357 464.27 626.66 240.00 120.00 540.00 60.00 10260.00
2007-S1 5309 493.84 715.63 240.00 120.00 600.00 60.00 18720.00
2007-S2 5272 469.56 616.12 240.00 120.00 540.00 60.00 10500.00
2008-S1 5396 508.90 749.19 240.00 120.00 600.00 60.00 14400.00
2008-S2 5357 479.46 664.10 240.00 120.00 540.00 60.00 9240.00
KCE Reports 125 Academic Detailing – Supplement 265
Volume in number of DDDs
N Mean Std Median Q1 Q3 Min Max
Others (Diabetes), including the medications in Metformin & Rosiglitazone
Visited GPs 2006-S1 101 578.01 670.07 315.00 180.00 690.00 15.00 3270.00
2006-S2 103 586.39 665.97 330.00 135.00 810.00 15.00 3540.00
2007-S1 108 644.21 783.76 360.00 150.00 682.50 15.00 3765.00
2007-S2 110 655.95 823.95 378.50 150.00 810.00 15.00 3825.00
2008-S1 116 782.53 968.22 390.00 180.00 979.00 15.00 4868.00
2008-S2 127 735.58 917.31 435.00 135.00 908.00 0.67 4948.67
Overall GPs 2006-S1 9921 509.99 689.23 255.00 75.00 660.00 15.00 10395.00
2006-S2 10089 502.65 671.67 255.00 75.00 645.00 15.00 9375.00
2007-S1 10299 533.86 717.43 270.00 90.00 690.00 0.00 11460.00
2007-S2 10430 540.39 718.05 270.00 90.00 705.00 15.00 9885.00
2008-S1 10921 607.69 822.62 300.00 90.00 795.00 0.00 14911.00
2008-S2 11189 635.94 831.26 330.00 98.00 840.00 0.00 11498.67
266 Academic Detailing – Supplement KCE reports 125
Volume in number of DDDs
N Mean Std Median Q1 Q3 Min Max
Sulfonylurea Visited GPs 2006-S1 144 1894.38 1699.95 1422.75 757.25 2526.25 30.00 10153.00
2006-S2 146 1846.28 1697.22 1313.75 691.50 2520.00 60.00 10882.00
2007-S1 146 1845.26 1680.90 1362.75 710.00 2388.00 90.00 9883.00
2007-S2 149 1792.90 1620.30 1320.00 650.50 2351.50 10.50 8979.00
2008-S1 150 1828.70 1673.14 1304.00 716.50 2460.00 15.00 9744.00
2008-S2 150 1817.72 1715.19 1301.75 768.50 2231.50 10.50 10352.00
Overall GPs 2006-S1 15648 1284.70 1615.47 732.00 140.00 1861.50 10.00 36151.50
2006-S2 15686 1237.61 1535.89 717.25 132.00 1790.00 10.00 31069.50
2007-S1 15620 1246.81 1570.77 722.00 132.00 1788.00 10.00 36933.50
2007-S2 15610 1205.62 1527.25 690.00 140.00 1726.00 10.00 43247.50
2008-S1 15724 1250.06 1621.65 707.50 132.00 1781.75 0.00 48238.00
2008-S2 15721 1206.05 1558.79 686.50 126.00 1734.00 0.00 44794.50
KCE Reports 125 Academic Detailing – Supplement 267
3.1.6 Proportion (in %) of the Medications prescriptions by Group of Medications, Population and Semesters – Diabetes
Proportion (in%) of prescriptions
N Mean Std Median Q1 Q3 Min Max
Group of Medications population semestre
80 5.33 4.51 3.51 1.62 7.89 0.28 17.57 Glitazones Visited GPs 2006-S1
2006-S2 76 5.34 4.38 3.55 1.95 8.46 0.44 18.05
2007-S1 82 6.71 11.36 3.99 2.04 8.03 0.32 100.00
2007-S2 77 5.89 5.06 3.64 2.09 9.58 0.24 21.21
2008-S1 75 5.94 5.20 3.61 1.95 9.03 0.16 21.52
2008-S2 73 4.62 4.12 2.83 1.62 7.06 0.12 18.51
Overall GPs 2006-S1 6432 7.10 10.80 4.14 1.97 8.20 0.00 100.00
2006-S2 6609 7.18 11.02 4.27 2.04 8.15 0.00 100.00
2007-S1 6710 6.90 9.75 4.21 2.06 8.40 0.06 100.00
2007-S2 6724 7.12 10.92 4.19 2.04 8.18 0.00 100.00
2008-S1 6403 6.63 9.86 4.08 1.95 7.83 0.00 100.00
2008-S2 6128 6.79 10.40 3.96 1.96 7.79 0.07 100.00
268 Academic Detailing – Supplement KCE reports 125
Proportion (in%) of prescriptions
N Mean Std Median Q1 Q3 Min Max
Metformin Visited GPs 2006-S1 148 48.83 15.82 47.49 37.87 57.62 14.49 100.00
2006-S2 149 49.34 15.22 48.27 38.02 58.94 13.40 100.00
2007-S1 149 50.28 15.23 48.94 39.54 59.06 17.06 100.00
2007-S2 153 51.98 15.48 50.72 42.07 61.32 4.16 100.00
2008-S1 155 53.83 16.73 51.33 43.34 63.56 13.72 100.00
2008-S2 155 55.22 15.37 53.32 44.76 64.24 26.57 100.00
Overall GPs 2006-S1 17094 55.48 23.19 50.97 39.29 67.15 1.05 100.00
2006-S2 17258 56.38 22.98 51.94 40.41 68.04 1.75 100.00
2007-S1 17229 57.40 22.60 53.32 41.58 69.08 0.00 100.00
2007-S2 17525 58.58 22.69 54.60 42.88 70.88 1.48 100.00
2008-S1 17925 60.27 22.49 56.50 44.74 73.00 0.00 100.00
2008-S2 17993 61.26 22.33 57.70 45.80 74.13 0.00 100.00
KCE Reports 125 Academic Detailing – Supplement 269
Proportion (in%) of prescriptions
N Mean Std Median Q1 Q3 Min Max
Metformin & derivates of Sulfonylurea Visited GPs 2006-S1 64 11.40 9.46 9.79 4.56 14.38 0.73 45.99
2006-S2 72 10.19 9.31 7.83 2.50 14.40 0.64 43.06
2007-S1 73 10.00 8.68 7.61 3.23 14.29 0.84 42.02
2007-S2 77 9.14 8.90 5.59 2.90 13.22 0.71 41.46
2008-S1 79 9.10 10.20 5.33 2.48 11.80 0.72 57.74
2008-S2 80 7.99 8.46 4.96 2.08 10.78 0.25 40.75
Overall GPs 2006-S1 5189 13.12 16.78 7.42 3.35 16.01 0.00 100.00
2006-S2 5357 12.63 16.01 7.17 3.25 15.53 0.22 100.00
2007-S1 5309 13.04 16.87 7.36 3.25 15.95 0.15 100.00
2007-S2 5272 12.52 16.32 7.04 3.22 14.92 0.14 100.00
2008-S1 5396 12.16 16.62 6.56 2.86 14.31 0.17 100.00
2008-S2 5357 11.44 15.85 6.09 2.80 13.20 0.11 100.00
270 Academic Detailing – Supplement KCE reports 125
Proportion (in%) of prescriptions
N Mean Std Median Q1 Q3 Min Max
Others (Diabetes), including the medications in Metformin & Rosiglitazone
Visited GPs 2006-S1 101 11.21 10.32 7.40 3.24 14.78 0.26 44.24
2006-S2 103 11.22 10.27 8.58 3.50 16.75 0.29 48.64
2007-S1 108 11.67 11.17 8.26 2.62 16.35 0.14 49.87
2007-S2 110 11.77 11.10 8.67 3.17 17.07 0.27 50.39
2008-S1 116 12.23 10.64 8.88 4.16 18.72 0.23 41.47
2008-S2 127 11.55 10.05 8.67 3.26 18.16 0.03 43.47
Overall GPs 2006-S1 9921 16.22 18.61 10.50 4.40 20.64 0.10 100.00
2006-S2 10089 15.87 18.02 10.33 4.44 20.45 0.07 100.00
2007-S1 10299 16.16 18.43 10.52 4.57 20.54 0.00 100.00
2007-S2 10430 16.22 18.27 10.64 4.64 20.69 0.10 100.00
2008-S1 10921 16.17 18.08 10.73 4.76 20.63 0.00 100.00
2008-S2 11189 16.42 17.87 11.27 5.21 20.83 0.00 100.00
KCE Reports 125 Academic Detailing – Supplement 271
Proportion (in%) of prescriptions
N Mean Std Median Q1 Q3 Min Max
Sulfonylurea Visited GPs 2006-S1 144 36.70 15.07 36.80 24.71 46.24 8.65 80.00
2006-S2 146 36.67 15.83 36.51 25.29 46.61 4.91 100.00
2007-S1 146 34.02 15.09 34.53 22.38 45.14 3.81 75.00
2007-S2 149 32.86 15.33 33.35 20.60 43.09 3.25 80.33
2008-S1 150 31.15 14.94 29.72 18.60 42.28 4.31 100.00
2008-S2 150 29.98 14.46 28.86 19.35 38.93 1.28 69.12
Overall GPs 2006-S1 15648 41.82 23.28 38.13 25.71 52.49 0.06 100.00
2006-S2 15686 40.87 23.10 37.04 24.90 50.87 0.05 100.00
2007-S1 15620 39.31 23.10 35.28 23.28 49.04 0.31 100.00
2007-S2 15610 38.12 22.99 34.04 22.17 47.66 0.12 100.00
2008-S1 15724 36.73 23.14 32.23 20.58 45.57 0.00 100.00
2008-S2 15721 35.48 23.15 30.64 19.80 43.96 0.00 100.00
272 Academic Detailing – Supplement KCE reports 125
3.2 DEMENTIA TOPIC
3.2.1 Descriptive statistics of the number of patients by GP – Overall Population
Statistics Value N 117 Mean (sd) 5 (3) Median 4 Q1 – Q3 2 – 6 Min – Max 1 - 23
3.2.2 Age distribution of the Patients analyzed for Dementia – Overall Population
Statistics Value N 543 Mean (sd) 82 (7) Median 82 Q1 – Q3 78 – 93 Min – Max 54 - 101
KCE Reports 125 Academic Detailing – Supplement 273
3.2.3 Number (%) of Patients by type of therapy given before and after the AD Visit for dementia topic – Overall Population
Therapy before
Therapy after
Total 0 1 2 3 4 5 6 7 8 9 10 11 0 0 42 3 20 2 0 12 2 2 2 0 0 85
0.00 7.73 0.55 3.68 0.37 0.00 2.21 0.37 0.37 0.37 0.00 0.00 15.65
1
26 102 0 0 1 0 28 0 0 0 0 8 165
4.79 18.78 0.00 0.00 0.18 0.00 5.16 0.00 0.00 0.00 0.00 1.47 30.39
2
7 0 21 0 0 0 0 2 0 0 0 0 30
1.29 0.00 3.87 0.00 0.00 0.00 0.00 0.37 0.00 0.00 0.00 0.00 5.52
3
10 2 0 33 1 0 0 0 2 0 0 3 51
1.84 0.37 0.00 6.08 0.18 0.00 0.00 0.00 0.37 0.00 0.00 0.55 9.39
4
6 0 0 0 16 0 0 0 0 8 0 2 32
1.10 0.00 0.00 0.00 2.95 0.00 0.00 0.00 0.00 1.47 0.00 0.37 5.89
5
2 0 0 0 0 1 0 0 0 0 0 0 3
0.37 0.00 0.00 0.00 0.00 0.18 0.00 0.00 0.00 0.00 0.00 0.00 0.55
6
7 15 0 0 0 0 40 0 0 0 0 9 71
1.29 2.76 0.00 0.00 0.00 0.00 7.37 0.00 0.00 0.00 0.00 1.66 13.08
7
1 0 6 0 0 0 0 9 0 0 0 3 19
0.18 0.00 1.10 0.00 0.00 0.00 0.00 1.66 0.00 0.00 0.00 0.55 3.50
8
3 0 0 6 0 0 0 0 12 0 0 5 26
0.55 0.00 0.00 1.10 0.00 0.00 0.00 0.00 2.21 0.00 0.00 0.92 4.79
274 Academic Detailing – Supplement KCE reports 125
Therapy before the AD Visit Therapy after the AD Visit Total
0 1 2 3 4 5 6 7 8 9 10 11
9
3 0 0 0 1 0 0 0 0 10 0 2 16
0.55 0.00 0.00 0.00 0.18 0.00 0.00 0.00 0.00 1.84 0.00 0.37 2.95
10
0 0 0 0 0 0 0 0 0 0 3 0 3
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.55 0.00 0.55
11
0 11 4 7 1 1 8 4 4 1 1 0 42
0.00 2.03 0.74 1.29 0.18 0.18 1.47 0.74 0.74 0.18 0.18 0.00 7.73
Total 65 172 34 66 22 2 88 17 20 21 4 32 543
11.97 31.68 6.26 12.15 4.05 0.37 16.21 3.13 3.68 3.87 0.74 5.89 100.00
0 = None/ data not available
1 = Donepezil
2 = Rivastigmine
3 = Galantamine
4 = Memantine
5 = Ginkgo Biloba
6 = Donepezil in association with Other(s)
7 = Rivastigmine in association with Other(s)
8 = Galantamine in association with Other(s)
9 = Memantine in association with Other(s)
10 = Ginkgo Biloba in association with Other(s)
11 = Other(s)
KCE Reports 125 Academic Detailing – Supplement 275
3.2.4 Volume (in number of Defined Daily Doses) by Group of Medications, Population and Semesters – Dementia
Volume in number of DDDs
N Mean Std Median Q1 Q3 Min Max
Group of medications population semestre
112 481.92 434.47 401.33 186.67 616.00 37.33 3047.32 Inhibitors of Cholinesterase Visited GPs 2006-S1
2006-S2 113 506.15 518.11 373.34 186.67 606.67 18.67 4130.00
2007-S1 111 555.00 465.65 448.00 242.67 756.00 18.67 3094.00
2007-S2 109 573.15 421.76 522.67 261.33 714.00 18.67 2193.34
2008-S1 115 592.95 488.56 466.67 242.67 886.67 18.67 3103.34
2008-S2 117 640.49 502.14 541.34 266.00 858.67 18.67 2781.34
Overall GPs 2006-S1 9205 402.71 470.54 270.67 121.33 532.00 9.33 11438.01
2006-S2 9412 422.95 499.62 294.00 126.00 560.00 9.33 11545.35
2007-S1 9431 455.41 532.86 308.00 149.33 606.66 9.33 11718.02
2007-S2 9774 466.50 545.56 308.00 149.33 625.33 9.33 12166.01
2008-S1 9906 511.78 612.92 350.00 149.33 681.33 9.33 16443.07
2008-S2 10039 535.51 655.05 364.00 149.33 714.00 9.33 19427.49
276 Academic Detailing – Supplement KCE reports 125
Volume in number of DDDs
N Mean Std Median Q1 Q3 Min Max
Memantine & Ginkgo Biloba Visited GPs 2006-S1 40 144.97 70.26 140.00 103.33 168.00 28.00 336.00
2006-S2 45 132.85 113.09 84.00 56.00 168.00 28.00 569.33
2007-S1 37 155.77 90.16 140.00 84.00 224.00 28.00 364.00
2007-S2 38 150.32 109.67 140.00 56.00 168.00 28.00 448.00
2008-S1 38 153.65 91.17 140.00 84.00 196.00 28.00 392.00
2008-S2 44 147.27 101.58 126.00 84.00 196.00 25.00 448.00
Overall GPs 2006-S1 2938 132.51 104.34 112.00 56.00 168.00 25.00 917.33
2006-S2 3086 132.94 106.72 112.00 56.00 168.00 0.00 1092.00
2007-S1 3140 138.64 112.30 112.00 56.00 178.00 0.00 1129.00
2007-S2 3298 135.66 111.36 112.00 56.00 168.00 25.00 1533.33
2008-S1 3417 140.28 121.72 112.00 56.00 178.67 0.00 1967.67
2008-S2 3543 143.16 120.24 112.00 56.00 196.00 25.00 1799.67
This page is left intentionally blank.
Legal depot : D/2010/10.273/17
KCE reports
33 Effects and costs of pneumococcal conjugate vaccination of Belgian children. D/2006/10.273/54. 34 Trastuzumab in Early Stage Breast Cancer. D/2006/10.273/25. 36 Pharmacological and surgical treatment of obesity. Residential care for severely obese children
in Belgium. D/2006/10.273/30. 37 Magnetic Resonance Imaging. D/2006/10.273/34. 38 Cervical Cancer Screening and Human Papillomavirus (HPV) Testing D/2006/10.273/37. 40 Functional status of the patient: a potential tool for the reimbursement of physiotherapy in
Belgium? D/2006/10.273/53. 47 Medication use in rest and nursing homes in Belgium. D/2006/10.273/70. 48 Chronic low back pain. D/2006/10.273.71. 49 Antiviral agents in seasonal and pandemic influenza. Literature study and development of
practice guidelines. D/2006/10.273/67. 54 Cost-effectiveness analysis of rotavirus vaccination of Belgian infants D/2007/10.273/11. 59 Laboratory tests in general practice D/2007/10.273/26. 60 Pulmonary Function Tests in Adults D/2007/10.273/29. 64 HPV Vaccination for the Prevention of Cervical Cancer in Belgium: Health Technology
Assessment. D/2007/10.273/43. 65 Organisation and financing of genetic testing in Belgium. D/2007/10.273/46. 66. Health Technology Assessment: Drug-Eluting Stents in Belgium. D/2007/10.273/49. 70. Comparative study of hospital accreditation programs in Europe. D/2008/10.273/03 71. Guidance for the use of ophthalmic tests in clinical practice. D/200810.273/06. 72. Physician workforce supply in Belgium. Current situation and challenges. D/2008/10.273/09. 74 Hyperbaric Oxygen Therapy: a Rapid Assessment. D/2008/10.273/15. 76. Quality improvement in general practice in Belgium: status quo or quo vadis?
D/2008/10.273/20 82. 64-Slice computed tomography imaging of coronary arteries in patients suspected for coronary
artery disease. D/2008/10.273/42 83. International comparison of reimbursement principles and legal aspects of plastic surgery.
D/200810.273/45 87. Consumption of physiotherapy and physical and rehabilitation medicine in Belgium.
D/2008/10.273/56 90. Making general practice attractive: encouraging GP attraction and retention D/2008/10.273/66. 91 Hearing aids in Belgium: health technology assessment. D/2008/10.273/69. 92. Nosocomial Infections in Belgium, part I: national prevalence study. D/2008/10.273/72. 93. Detection of adverse events in administrative databases. D/2008/10.273/75. 95. Percutaneous heart valve implantation in congenital and degenerative valve disease. A rapid
Health Technology Assessment. D/2008/10.273/81 100. Threshold values for cost-effectiveness in health care. D/2008/10.273/96 102. Nosocomial Infections in Belgium: Part II, Impact on Mortality and Costs. D/2009/10.273/03 103 Mental health care reforms: evaluation research of ‘therapeutic projects’ - first intermediate
report. D/2009/10.273/06. 104. Robot-assisted surgery: health technology assessment. D/2009/10.273/09 108. Tiotropium in the Treatment of Chronic Obstructive Pulmonary Disease: Health Technology
Assessment. D/2009/10.273/20 109. The value of EEG and evoked potentials in clinical practice. D/2009/10.273/23 111. Pharmaceutical and non-pharmaceutical interventions for Alzheimer’s Disease, a rapid
assessment. D/2009/10.273/29 112. Policies for Orphan Diseases and Orphan Drugs. D/2009/10.273/32. 113. The volume of surgical interventions and its impact on the outcome: feasibility study based on
Belgian data 114. Endobronchial valves in the treatment of severe pulmonary emphysema. A rapid Health
Technology Assessment. D/2009/10.273/39 115. Organisation of palliative care in Belgium. D/2009/10.273/42 116. Interspinous implants and pedicle screws for dynamic stabilization of lumbar spine: Rapid
assessment. D/2009/10.273/46
117. Use of point-of care devices in patients with oral anticoagulation: a Health Technology Assessment. D/2009/10.273/49.
118. Advantages, disadvantages and feasibility of the introduction of ‘Pay for Quality’ programmes in Belgium. D/2009/10.273/52.
119. Non-specific neck pain: diagnosis and treatment. D/2009/10.273/56. 121. Feasibility study of the introduction of an all-inclusive case-based hospital financing system in
Belgium. D/2010/10.273/03 122. Financing of home nursing in Belgium. D/2010/10.273/07 123. Mental health care reforms: evaluation research of ‘therapeutic projects’ - second intermediate
report. D/2010/10.273/10 124. Organisation and financing of chronic dialysis in Belgium. D/2010/10.273/13 125. Impact of academic detailing on primary care physicians. D/2010/10.273/16 This list only includes those KCE reports for which a full English version is available. However, all KCE reports are available with a French or Dutch executive summary and often contain a scientific summary in English.